RE: Fw: LBP case... follow up2

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I often read commentary on this list servethat is outright basing of the medical profession. I am a DC. A DC commentingon DC care is intraprofessional critique which is what we should do more of. Weknow little or nothing about the medical profession and they know little ornothing about us. If we keep the focus on us we can improve and expand ourknowledge and view. ‘Cut , Burn and Poison’ was the mantraspewed at WSCC when I was there. I hear it used by DC’s still. s. fuchs dc From: Lindekugel[mailto:pdxchiroguy@...] Sent: Friday, November 07, 20085:24 PMSharron Fuchs; Subject: Re: Fw:LBP case... follow up2 I guess that is just it. I don't see anybody saying ‘You hear me Darla, all MD’s are nothing but cut, burn and poison.There is nothing they do or say that can help you. Only I can helpyou………………….’. Who is doing this? Is this what you think we are saying to our patients? I think thecomments below and discussing the dangers (namely backed by numbers) is justwhat we are supposed to be aware of as responsible physicians. This isnot MD bashing any more than you sharing your encounter with thechiropractor and the 90 year old was chiro-bashing.Jay Lindekugel, DCConcordia Chiropractic CenterFrom: SharronFuchs <sharronf@...> Lindekugel<pdxchiroguy@...>; Sent: Friday, November 7, 20084:19:21 PMSubject: RE: Fw:LBP case... follow up2You know darn well that is not what Imean. Bad mouth = ‘You hear me Darla, all MD’s are nothing but cut, burn andpoison. There is nothing they do or say that can help you. Only I can helpyou………………….’ s. fuchs dc From: Lindekugel[mailto:pdxchiroguy@...] Sent: Friday, November 07, 20084:13 PMSharron Fuchs; Subject: Re: Fw:LBP case... follow up2 If by " bad mouth " you meanexplaining to patients faced with difficult decisions the importance ofweighing the risk benefit ratio of different procedures - includingchiropractic - ... ...guilty ascharged.Jay Lindekugel, DCConcordia Chiropractic Center From: SharronFuchs <sharronf@...> Sent: Friday, November 7, 20082:36:44 PMSubject: RE: Fw:LBP case... follow up2 Yes, there are many stories to goaround. For us, I think we should not bad mouth others but rather seek ways forus to improve what we do. s. fuchs dc From: Lindekugel[mailto:pdxchiroguy @] Sent: Friday, November 07, 20081:55 PMSharron Fuchs;@grou ps.comSubject: Re: Fw:LBP case... follow up2 Agreed. And thanks for the article reference. That was veryhelpful. I am sure we are all guilty of a little bias in our decisionmaking. But I would say that on balance, we do less harm than our medicalcounterparts when it comes to diagnosing and treating patients.A year ago I attended one of many Pain Society of Oregon meetings where theywere having a panel discussion about some difficult cases one of theneurologists in the group had brought to discuss. The first case was awomen in her 50's who had been suffering from severe debilitating headpain. Many drugs had been tried over the years - mostly opiates. When that failed, they decided to remove part of her BRAIN - no change. Theyturned to the acupuncturist and chiropractor on the panel to discuss treatmentoptions. Both discussed how they might begin to work with thisindividual. The main point not made was that chiropractic and acupunctureshould have been tried BEFORE taking part of this poor woman's brain out andthey created a severe depletion of neurotransmitters, hormone imbalances andGod know what else. Most of us see this side of the story too often, and I think accounts for someof our zealous behavior. You have seen the other side. It isinexcusable, and we should all be honest about our patient's options and makecertain that they are consenting and knowledgeable. Not everyone wants what we have to offer. If they are not on board, theyshould be given a choice of alternatives - with your professional " take " on what you think is best for their health. But most ofus have seen countless patients who have been held " hostage " bybiased medical practitioners. Patients who say, " I don't know why myMD thought you were going to paralyze me, this is the best thing I have everdone for my health! I am so happy my friend/loved one talked me intoseeing you. " Jay Lindekugel, DCConcordia Chiropractic and MovementCenter From: SharronFuchs <sharronf@tdinjuryla w.com>@grou ps.comSent: Friday, November 7, 200811:04:29 AMSubject: RE: Fw:LBP case... follow up2Of course. They need to wake up too towhat can be a legitimate option for the patient. We have to be smarter. We alsohave to accept the idea and even admit that there are risks to our treatmentsalso. s. fuchs From:@grou ps.com[mailto:] OnBehalf Of SeitzSent: Friday, November 07, 200811:02 AM@grou ps.comSubject: RE: Fw:LBP case... follow up2 Of course the flip-side to this is thevery common bias against what chiropractors do by the medical profession, especiallywhen related to manual adjusting of the upper cervical spine. Seitz, DC From:@grou ps.com [mailto:] On Behalf Of Sharron FuchsSent: Friday, November 07, 200810:35 AMSubject: RE: Fw:LBP case... follow up2 Only the patient can make thedetermination of their pain level and what options they wish to try for relief.I don’t think it is up to us to bias them about all the negatives when in somecases it might be of great benefit. I know you know that. I don’t want to argueabout it but this is a sensitive point for me as I was posting in the pastabout a 90 year old person who was suffering terribly and the DC that wastreating them essentially held them hostage in their pain to their bias. It wasabuse in my mind and I think we need to consider all things that might help thebenefit as we practice to the standard of providing adequate pain relief. s. fuchs dc From:@grou ps.com [mailto:] On Behalf Of joe medlinSent: Friday, November 07, 200810:22 AM Lindekugel; Marc Heller;glenntamearthlink (DOT) net ; W. Pfeiffer, DCCc: Subject: Re: Fw:LBP case... follow up2  Despite the fact that the risks may be remote, it's advisable for apatients to understand that arachnoiditis, nerve root damage, infection etc.are inherant risks. Not to mention the damage the steroid does to the rest ofthe body. Theres a reason they only allow 3/year. They only help about 50% andthats only temporary. THey should be reserved for extreme cases ofstenosis in my opinion not a mild bulge such as we see in this case. Anargument can also be made that it will slow healing time down in the long run. ph Medlin D.C.Spine Tree Chiropractic1607 NE Alberta St. PDX, OR 97211www.spinetreepdx. com* Re: LBP case>> > >> > I have a 52yr old male (desk worker) with severe> LBP(8/10 VAS),> gradual onset over the coarse of a few hours, about 2> weeks ago.> Pain levels have been increasing, and now he is also> getting a " numb> feeling " into his anterior left thigh, medial knee and medial> proximal calf. His only position of relief for LBP is> squatting.> Can't find relief for the numbness.> >> > exam: Initially neuro exam was negative but now loss> (0/2) of> Patella reflex on left. Sensation still intact, Lower> extremity str> all +5/5, except iliopsoas +3/5 due to local LBP, heel and> toe walk> neg. SLR/SLR max both neg. Kemps neg. Stretching of> iliopsoas or> piriformis gave an immediate relief of symptoms (1/10 VAS)> >> > I have done 3 treatments consisting of massage, stretch> of affected> muscles, microcurrent, and side posture manual adjustment.> Home> stretches were assigned. We also have a naturopath and an> acupuncturist in our office and he received acupuncture as> well as> Trameel injections into the piriformis. Each treatment> helped for a> few days. Before symptoms would return, and worse than> before. Home> stretching only gives small and temporary relief.> >> > Due to appearance of neuro finding I sent him for a MRI:> > finding: mild bulge with a small annular tear L4-5> >> > First any ideas for annular tears.> >> > Second, I am fairly confident that the leg numbness is a> parathesia> and is referred from the muscle spasm and not due to nerve> root> impingement. Due to the fact I am able to reduce the> numbness and> back pain with in-office stretching, SLR max is negative and> adjusting helps so dramatically and quickly.> >> > However I am concerned about the loss of patellar> reflex, and the> patient is concerned about long term neurological> ramifications, so> does anyone have a good neuro referral in the East side of> Portland .> >> > thank you all in advance.> >> > Glenn Sykes, DC> > Gresham/Newberg, Oregon> > 503-550-8806> >Don't give up to soon. Ultrasound right over the piriformis> (O,I,Belly)everytim e and stretching to release it will> help. Getting> the inflamation down in the piriformis is critical. I have> seen the> reflexes come back to normal in two to three weeks.>> Brad Rethwill , DC> Eugene , OR>> > ------------ --------- --------- --------- --------- --------- ->>> No virus found in this incoming message.> Checked by AVG - http://www.avg.com > Version: 8.0.175 / Virus Database: 270.8.6/1768 - Release Date: 11/4/20089:38 PM>> ------------ --------- --------- ------All posts must adhere to OregonDCs rules located on homepage at: group//Tell a colleague about OregonDCs! (must be licensed Oregon DC)

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Your words of caution about making other specialties 'wrong' are well taken. What you don't see - given the role you play in our state and profession - is the frequent, persistent, severe mismanagement that is done with cases belonging in our arena....things that we have to 'undo' a dozen times a week....things that, had they presented in our offices initially, would have taken a S H O R T time to correct and resolve. For example: one of my last w/c cases came into me after 6 months of being shunted 7 other directions but chiropractic....had the lady off work for 6 months, allowing her headache and cranial disruption to exponentiate, ultimately involving the entire body, telling her that returning to work was not going to be an option, that she would never be able to hold down a job again .... took me 5 weeks to get her back to par and capability ... in the meantime she lost her house. being a responsible doctor, I said nothing to her while she was in my office ... but my degree of muttering after she left could have been felt in Canada! Traditional medicine should not be allowed to TOUCH a structural case until a chiropractor has been consulted. my 2 cents this beautiful drippy morning. SunnySunny Kierstyn, RN DC Fibromyalgia Care Center of Oregon 2677 Willakenzie Road, 7CEugene, Oregon, 97401541- 344- 0509; Fx; 541- 344- 0955 From: sharronf@...Date: Mon, 10 Nov 2008 11:10:37 -0800Subject: RE: Fw: LBP case... follow up2I often read commentary on this list serve that is outright basing of the medical profession. I am a DC. A DC commenting on DC care is intraprofessional critique which is what we should do more of. We know little or nothing about the medical profession and they know little or nothing about us. If we keep the focus on us we can improve and expand our knowledge and view. ‘Cut , Burn and Poison’ was the mantra spewed at WSCC when I was there. I hear it used by DC’s still. s. fuchs dc From: Lindekugel [mailto:pdxchiroguy ] Sent: Friday, November 07, 2008 5:24 PMSharron Fuchs; Subject: Re: Fw: LBP case... follow up2 I guess that is just it. I don't see anybody saying ‘You hear me Darla, all MD’s are nothing but cut, burn and poison. There is nothing they do or say that can help you. Only I can help you………………….’. Who is doing this? Is this what you think we are saying to our patients? I think the comments below and discussing the dangers (namely backed by numbers) is just what we are supposed to be aware of as responsible physicians. This is not MD bashing any more than you sharing your encounter with the chiropractor and the 90 year old was chiro-bashing.Jay Lindekugel, DCConcordia Chiropractic CenterFrom: Sharron Fuchs <sharronftdinjurylaw> Lindekugel <pdxchiroguy >; Sent: Friday, November 7, 2008 4:19:21 PMSubject: RE: Fw: LBP case... follow up2You know darn well that is not what I mean. Bad mouth = ‘You hear me Darla, all MD’s are nothing but cut, burn and poison. There is nothing they do or say that can help you. Only I can help you………………….’ s. fuchs dc From: Lindekugel [mailto:pdxchiroguy ] Sent: Friday, November 07, 2008 4:13 PMSharron Fuchs; Subject: Re: Fw: LBP case... follow up2 If by "bad mouth" you mean explaining to patients faced with difficult decisions the importance of weighing the risk benefit ratio of different procedures - including chiropractic - ... ...guilty as charged.Jay Lindekugel, DCConcordia Chiropractic Center From: Sharron Fuchs <sharronftdinjurylaw> Sent: Friday, November 7, 2008 2:36:44 PMSubject: RE: Fw: LBP case... follow up2 Yes, there are many stories to go around. For us, I think we should not bad mouth others but rather seek ways for us to improve what we do. s. fuchs dc From: Lindekugel [mailto:pdxchiroguy @] Sent: Friday, November 07, 2008 1:55 PMSharron Fuchs; @grou ps.comSubject: Re: Fw: LBP case... follow up2 Agreed. And thanks for the article reference. That was very helpful. I am sure we are all guilty of a little bias in our decision making. But I would say that on balance, we do less harm than our medical counterparts when it comes to diagnosing and treating patients.A year ago I attended one of many Pain Society of Oregon meetings where they were having a panel discussion about some difficult cases one of the neurologists in the group had brought to discuss. The first case was a women in her 50's who had been suffering from severe debilitating head pain. Many drugs had been tried over the years - mostly opiates. When that failed, they decided to remove part of her BRAIN - no change. They turned to the acupuncturist and chiropractor on the panel to discuss treatment options. Both discussed how they might begin to work with this individual. The main point not made was that chiropractic and acupuncture should have been tried BEFORE taking part of this poor woman's brain out and they created a severe depletion of neurotransmitters, hormone imbalances and God know what else. Most of us see this side of the story too often, and I think accounts for some of our zealous behavior. You have seen the other side. It is inexcusable, and we should all be honest about our patient's options and make certain that they are consenting and knowledgeable. Not everyone wants what we have to offer. If they are not on board, they should be given a choice of alternatives - with your professional "take" on what you think is best for their health. But most of us have seen countless patients who have been held "hostage" by biased medical practitioners. Patients who say, "I don't know why my MD thought you were going to paralyze me, this is the best thing I have ever done for my health! I am so happy my friend/loved one talked me into seeing you."Jay Lindekugel, DCConcordia Chiropractic and Movement Center From: Sharron Fuchs <sharronf@tdinjuryla w.com>@grou ps.comSent: Friday, November 7, 2008 11:04:29 AMSubject: RE: Fw: LBP case... follow up2Of course. They need to wake up too to what can be a legitimate option for the patient. We have to be smarter. We also have to accept the idea and even admit that there are risks to our treatments also. s. fuchs From: @grou ps.com [mailto:] On Behalf Of SeitzSent: Friday, November 07, 2008 11:02 AM@grou ps.comSubject: RE: Fw: LBP case... follow up2 Of course the flip-side to this is the very common bias against what chiropractors do by the medical profession, especially when related to manual adjusting of the upper cervical spine. Seitz, DC From: @grou ps.com [mailto:] On Behalf Of Sharron FuchsSent: Friday, November 07, 2008 10:35 AMSubject: RE: Fw: LBP case... follow up2 Only the patient can make the determination of their pain level and what options they wish to try for relief. I don’t think it is up to us to bias them about all the negatives when in some cases it might be of great benefit. I know you know that. I don’t want to argue about it but this is a sensitive point for me as I was posting in the past about a 90 year old person who was suffering terribly and the DC that was treating them essentially held them hostage in their pain to their bias. It was abuse in my mind and I think we need to consider all things that might help the benefit as we practice to the standard of providing adequate pain relief. s. fuchs dc From: @grou ps.com [mailto:] On Behalf Of joe medlinSent: Friday, November 07, 2008 10:22 AM Lindekugel; Marc Heller; glenntamearthlink (DOT) net ; W. Pfeiffer , DCCc: Subject: Re: Fw: LBP case... follow up2  Despite the fact that the risks may be remote, it's advisable for a patients to understand that arachnoiditis, nerve root damage, infection etc. are inherant risks. Not to mention the damage the steroid does to the rest of the body. Theres a reason they only allow 3/year. They only help about 50% and thats only temporary. THey should be reserved for extreme cases of stenosis in my opinion not a mild bulge such as we see in this case. An argument can also be made that it will slow healing time down in the long run. ph Medlin D.C.Spine Tree Chiropractic1607 NE Alberta St . PDX, OR 97211www.spinetreepdx. com* Re: LBP case>> > >> > I have a 52yr old male (desk worker) with severe> LBP(8/10 VAS),> gradual onset over the coarse of a few hours, about 2> weeks ago.> Pain levels have been increasing, and now he is also> getting a "numb> feeling" into his anterior left thigh, medial knee and medial> proximal calf. His only position of relief for LBP is> squatting.> Can't find relief for the numbness.> >> > exam: Initially neuro exam was negative but now loss> (0/2) of> Patella reflex on left. Sensation still intact, Lower> extremity str> all +5/5, except iliopsoas +3/5 due to local LBP, heel and> toe walk> neg. SLR/SLR max both neg. Kemps neg. Stretching of> iliopsoas or> piriformis gave an immediate relief of symptoms (1/10 VAS)> >> > I have done 3 treatments consisting of massage, stretch> of affected> muscles, microcurrent, and side posture manual adjustment.> Home> stretches were assigned. We also have a naturopath and an> acupuncturist in our office and he received acupuncture as> well as> Trameel injections into the piriformis. Each treatment> helped for a> few days. Before symptoms would return, and worse than> before. Home> stretching only gives small and temporary relief.> >> > Due to appearance of neuro finding I sent him for a MRI:> > finding: mild bulge with a small annular tear L4-5> >> > First any ideas for annular tears.> >> > Second, I am fairly confident that the leg numbness is a> parathesia> and is referred from the muscle spasm and not due to nerve> root> impingement. Due to the fact I am able to reduce the> numbness and> back pain with in-office stretching, SLR max is negative and> adjusting helps so dramatically and quickly.> >> > However I am concerned about the loss of patellar> reflex, and the> patient is concerned about long term neurological> ramifications, so> does anyone have a good neuro referral in the East side of> Portland .> >> > thank you all in advance.> >> > Glenn Sykes, DC> > Gresham/Newberg, Oregon> > 503-550-8806> >Don't give up to soon. Ultrasound right over the piriformis> (O,I,Belly)everytim e and stretching to release it will> help. Getting> the inflamation down in the piriformis is critical. I have> seen the> reflexes come back to normal in two to three weeks.>> Brad Rethwill , DC> Eugene , OR>> > ------------ --------- --------- --------- --------- --------- ->>> No virus found in this incoming message.> Checked by AVG - http://www.avg. com > Version: 8.0.175 / Virus Database: 270.8.6/1768 - Release Date: 11/4/2008 9:38 PM>> ------------ --------- --------- ------All posts must adhere to OregonDCs rules located on homepage at: http://groups. / group//Tell a colleague about OregonDCs! (must be licensed Oregon DC )

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I do ‘see’ it. I absolutely advocate theDC being the first doctor to see for the cases we can handle. As per the casebelow, have the patient file a complaint with the WC division ,case manager andthe board who oversees them. s. fuchs dc From: Sunny Kierstyn[mailto:skrndc1@...] Sent: Monday, November 10, 200811:57 AMSharron Fuchs; Subject: RE: Fw:LBP case... follow up2 Your words of caution about makingother specialties 'wrong' are well taken. What you don't see - giventhe role you play in our state and profession - is the frequent, persistent,severe mismanagement that is done with cases belonging in our arena....thingsthat we have to 'undo' a dozen times a week....things that, had theypresented in our offices initially, would have taken a S H O R T time tocorrect and resolve. For example: one of my last w/c cases came into me after 6 months ofbeing shunted 7 other directions but chiropractic....had the lady off work for6 months, allowing her headache and cranial disruption to exponentiate,ultimately involving the entire body, telling her that returning to workwas not going to be an option, that she would never be able to hold down a jobagain .... took me 5 weeks to get her back to par and capability ... in the meantimeshe lost her house. being a responsible doctor, I said nothing to her while she was in my office... but my degree of muttering after she left could have been felt in Canada! Traditional medicine should not be allowed to TOUCH a structural case until achiropractor has been consulted. my 2 cents this beautiful drippy morning. SunnySunny Kierstyn, RN DC Fibromyalgia CareCenter of Oregon 2677 Willakenzie Road, 7CEugene, Oregon,97401541- 344- 0509; Fx; 541- 344- 0955 From: sharronf@...Date: Mon, 10 Nov 2008 11:10:37 -0800Subject: RE: Fw: LBP case... follow up2I often read commentary on this list servethat is outright basing of the medical profession. I am a DC. A DC commentingon DC care is intraprofessional critique which is what we should do more of. Weknow little or nothing about the medical profession and they know little ornothing about us. If we keep the focus on us we can improve and expand ourknowledge and view. ‘Cut , Burn and Poison’ was the mantraspewed at WSCC when I was there. I hear it used by DC’s still. s. fuchs dc From: Lindekugel[mailto:pdxchiroguy ] Sent: Friday, November 07, 20085:24 PMSharron Fuchs; Subject: Re: Fw:LBP case... follow up2 I guess that is just it. I don't see anybody saying ‘You hear me Darla, all MD’s are nothing but cut, burn and poison.There is nothing they do or say that can help you. Only I can helpyou………………….’. Who is doing this? Is this what you think we are saying to ourpatients? I think the comments below and discussing the dangers (namelybacked by numbers) is just what we are supposed to be aware of as responsiblephysicians. This is not MD bashing any more than you sharing yourencounter with the chiropractor and the 90 year old was chiro-bashing.Jay Lindekugel, DCConcordia Chiropractic CenterFrom: Sharron Fuchs<sharronftdinjurylaw> Lindekugel<pdxchiroguy >; Sent: Friday, November 7, 20084:19:21 PMSubject: RE: Fw:LBP case... follow up2You know darn well that is not what Imean. Bad mouth = ‘You hear me Darla, all MD’s are nothing but cut, burn andpoison. There is nothing they do or say that can help you. Only I can helpyou………………….’ s. fuchs dc From: Lindekugel[mailto:pdxchiroguy ] Sent: Friday, November 07, 20084:13 PMSharron Fuchs; Subject: Re: Fw:LBP case... follow up2 If by " bad mouth " you meanexplaining to patients faced with difficult decisions the importance ofweighing the risk benefit ratio of different procedures - includingchiropractic - ... ...guilty ascharged.Jay Lindekugel, DCConcordia Chiropractic Center From: SharronFuchs <sharronftdinjurylaw> Sent: Friday, November 7, 20082:36:44 PMSubject: RE: Fw:LBP case... follow up2 Yes, there are many stories to goaround. For us, I think we should not bad mouth others but rather seek ways forus to improve what we do. s. fuchs dc From: Lindekugel[mailto:pdxchiroguy @] Sent: Friday, November 07, 20081:55 PMSharron Fuchs;@grou ps.comSubject: Re: Fw:LBP case... follow up2 Agreed. And thanks for the article reference. That was veryhelpful. I am sure we are all guilty of a little bias in our decisionmaking. But I would say that on balance, we do less harm than our medicalcounterparts when it comes to diagnosing and treating patients.A year ago I attended one of many Pain Society of Oregon meetings where theywere having a panel discussion about some difficult cases one of theneurologists in the group had brought to discuss. The first case was awomen in her 50's who had been suffering from severe debilitating headpain. Many drugs had been tried over the years - mostly opiates. When that failed, they decided to remove part of her BRAIN - no change. They turned to the acupuncturist and chiropractor on the panel to discusstreatment options. Both discussed how they might begin to work with thisindividual. The main point not made was that chiropractic and acupunctureshould have been tried BEFORE taking part of this poor woman's brain out andthey created a severe depletion of neurotransmitters, hormone imbalances andGod know what else. Most of us see this side of the story too often, and I think accounts for someof our zealous behavior. You have seen the other side. It isinexcusable, and we should all be honest about our patient's options and makecertain that they are consenting and knowledgeable. Not everyone wants what we have to offer. If they are not on board, theyshould be given a choice of alternatives - with your professional " take " on what you think is best for their health. But most ofus have seen countless patients who have been held " hostage " bybiased medical practitioners. Patients who say, " I don't know why myMD thought you were going to paralyze me, this is the best thing I have everdone for my health! I am so happy my friend/loved one talked me into seeingyou. " Jay Lindekugel, DCConcordia Chiropractic and MovementCenter From: Sharron Fuchs<sharronf@tdinjuryla w.com>@grou ps.comSent: Friday, November 7, 200811:04:29 AMSubject: RE: Fw:LBP case... follow up2Of course. They need to wake up too towhat can be a legitimate option for the patient. We have to be smarter. We alsohave to accept the idea and even admit that there are risks to our treatmentsalso. s. fuchs From:@grou ps.com [mailto:groups (DOT) com] On Behalf Of SeitzSent: Friday, November 07, 200811:02 AM@grou ps.comSubject: RE: Fw:LBP case... follow up2 Of course the flip-side to this is thevery common bias against what chiropractors do by the medical profession,especially when related to manual adjusting of the upper cervical spine. Seitz, DC From:@grou ps.com [mailto:] On Behalf Of Sharron FuchsSent: Friday, November 07, 200810:35 AMSubject: RE: Fw:LBP case... follow up2 Only the patient can make thedetermination of their pain level and what options they wish to try for relief.I don’t think it is up to us to bias them about all the negatives when in somecases it might be of great benefit. I know you know that. I don’t want to argueabout it but this is a sensitive point for me as I was posting in the pastabout a 90 year old person who was suffering terribly and the DC that wastreating them essentially held them hostage in their pain to their bias. It wasabuse in my mind and I think we need to consider all things that might help thebenefit as we practice to the standard of providing adequate pain relief. s. fuchs dc From:@grou ps.com [mailto:] On Behalf Of joe medlinSent: Friday, November 07, 200810:22 AM Lindekugel; Marc Heller;glenntamearthlink (DOT) net ; W. Pfeiffer, DCCc: Subject: Re: Fw:LBP case... follow up2  Despite the fact that the risks may be remote, it's advisable for apatients to understand that arachnoiditis, nerve root damage, infection etc.are inherant risks. Not to mention the damage the steroid does to the rest ofthe body. Theres a reason they only allow 3/year. They only help about 50% andthats only temporary. THey should be reserved for extreme cases ofstenosis in my opinion not a mild bulge such as we see in this case. Anargument can also be made that it will slow healing time down in the long run. ph Medlin D.C.Spine Tree Chiropractic1607 NE Alberta St. PDX, OR 97211www.spinetreepdx. com* Re: LBP case>> > >> > I have a 52yr old male (desk worker) with severe> LBP(8/10 VAS),> gradual onset over the coarse of a few hours, about 2> weeks ago.> Pain levels have been increasing, and now he is also> getting a " numb> feeling " into his anterior left thigh, medial knee and medial> proximal calf. His only position of relief for LBP is> squatting.> Can't find relief for the numbness.> >> > exam: Initially neuro exam was negative but now loss> (0/2) of> Patella reflex on left. Sensation still intact, Lower> extremity str> all +5/5, except iliopsoas +3/5 due to local LBP, heel and> toe walk> neg. SLR/SLR max both neg. Kemps neg. Stretching of> iliopsoas or> piriformis gave an immediate relief of symptoms (1/10 VAS)> >> > I have done 3 treatments consisting of massage, stretch> of affected> muscles, microcurrent, and side posture manual adjustment.> Home> stretches were assigned. We also have a naturopath and an> acupuncturist in our office and he received acupuncture as> well as> Trameel injections into the piriformis. Each treatment> helped for a> few days. Before symptoms would return, and worse than> before. Home> stretching only gives small and temporary relief.> >> > Due to appearance of neuro finding I sent him for a MRI:> > finding: mild bulge with a small annular tear L4-5> >> > First any ideas for annular tears.> >> > Second, I am fairly confident that the leg numbness is a> parathesia> and is referred from the muscle spasm and not due to nerve> root> impingement. Due to the fact I am able to reduce the> numbness and> back pain with in-office stretching, SLR max is negative and> adjusting helps so dramatically and quickly.> >> > However I am concerned about the loss of patellar> reflex, and the> patient is concerned about long term neurological> ramifications, so> does anyone have a good neuro referral in the East side of> Portland .> >> > thank you all in advance.> >> > Glenn Sykes, DC> > Gresham/Newberg, Oregon> > 503-550-8806> >Don't give up to soon. Ultrasound right over the piriformis> (O,I,Belly)everytim e and stretching to release it will> help. Getting> the inflamation down in the piriformis is critical. I have> seen the> reflexes come back to normal in two to three weeks.>> Brad Rethwill , DC> Eugene , OR>> > ------------ --------- --------- --------- --------- --------- ->>> No virus found in this incoming message.> Checked by AVG - http://www.avg. com > Version: 8.0.175 / Virus Database: 270.8.6/1768 - Release Date: 11/4/20089:38 PM>> ------------ --------- --------- ------All posts must adhere to OregonDCs rules located on homepage at: http://groups. /group//Tell a colleague about OregonDCs! (must be licensed Oregon DC)

[Guest guest]

done, done and done ... she still lost her house. SunnySunny Kierstyn, RN DC Fibromyalgia Care Center of Oregon 2677 Willakenzie Road, 7CEugene, Oregon, 97401541- 344- 0509; Fx; 541- 344- 0955 From: sharronf@...Date: Mon, 10 Nov 2008 12:11:16 -0800Subject: RE: Fw: LBP case... follow up2I do ‘see’ it. I absolutely advocate the DC being the first doctor to see for the cases we can handle. As per the case below, have the patient file a complaint with the WC division ,case manager and the board who oversees them. s. fuchs dc From: Sunny Kierstyn [mailto:skrndc1msn] Sent: Monday, November 10, 2008 11:57 AMSharron Fuchs; Subject: RE: Fw: LBP case... follow up2 Your words of caution about making other specialties 'wrong' are well taken. What you don't see - given the role you play in our state and profession - is the frequent, persistent, severe mismanagement that is done with cases belonging in our arena....things that we have to 'undo' a dozen times a week....things that, had they presented in our offices initially, would have taken a S H O R T time to correct and resolve. For example: one of my last w/c cases came into me after 6 months of being shunted 7 other directions but chiropractic....had the lady off work for 6 months, allowing her headache and cranial disruption to exponentiate, ultimately involving the entire body, telling her that returning to work was not going to be an option, that she would never be able to hold down a job again .... took me 5 weeks to get her back to par and capability ... in the meantime she lost her house. being a responsible doctor, I said nothing to her while she was in my office ... but my degree of muttering after she left could have been felt in Canada! Traditional medicine should not be allowed to TOUCH a structural case until a chiropractor has been consulted. my 2 cents this beautiful drippy morning. SunnySunny Kierstyn, RN DC Fibromyalgia Care Center of Oregon 2677 Willakenzie Road, 7CEugene, Oregon, 97401541- 344- 0509; Fx; 541- 344- 0955 From: sharronftdinjurylawDate: Mon, 10 Nov 2008 11:10:37 -0800Subject: RE: Fw: LBP case... follow up2I often read commentary on this list serve that is outright basing of the medical profession. I am a DC. A DC commenting on DC care is intraprofessional critique which is what we should do more of. We know little or nothing about the medical profession and they know little or nothing about us. If we keep the focus on us we can improve and expand our knowledge and view. ‘Cut , Burn and Poison’ was the mantra spewed at WSCC when I was there. I hear it used by DC’s still. s. fuchs dc From: Lindekugel [mailto:pdxchiroguy ] Sent: Friday, November 07, 2008 5:24 PMSharron Fuchs; Subject: Re: Fw: LBP case... follow up2 I guess that is just it. I don't see anybody saying ‘You hear me Darla, all MD’s are nothing but cut, burn and poison. There is nothing they do or say that can help you. Only I can help you………………….’. Who is doing this? Is this what you think we are saying to our patients? I think the comments below and discussing the dangers (namely backed by numbers) is just what we are supposed to be aware of as responsible physicians. This is not MD bashing any more than you sharing your encounter with the chiropractor and the 90 year old was chiro-bashing.Jay Lindekugel, DCConcordia Chiropractic CenterFrom: Sharron Fuchs <sharronftdinjurylaw> Lindekugel <pdxchiroguy >; Sent: Friday, November 7, 2008 4:19:21 PMSubject: RE: Fw: LBP case... follow up2You know darn well that is not what I mean. Bad mouth = ‘You hear me Darla, all MD’s are nothing but cut, burn and poison. There is nothing they do or say that can help you. Only I can help you………………….’ s. fuchs dc From: Lindekugel [mailto:pdxchiroguy ] Sent: Friday, November 07, 2008 4:13 PMSharron Fuchs; Subject: Re: Fw: LBP case... follow up2 If by "bad mouth" you mean explaining to patients faced with difficult decisions the importance of weighing the risk benefit ratio of different procedures - including chiropractic - ... ...guilty as charged.Jay Lindekugel, DCConcordia Chiropractic Center From: Sharron Fuchs <sharronftdinjurylaw> Sent: Friday, November 7, 2008 2:36:44 PMSubject: RE: Fw: LBP case... follow up2 Yes, there are many stories to go around. For us, I think we should not bad mouth others but rather seek ways for us to improve what we do. s. fuchs dc From: Lindekugel [mailto:pdxchiroguy @] Sent: Friday, November 07, 2008 1:55 PMSharron Fuchs; @grou ps.comSubject: Re: Fw: LBP case... follow up2 Agreed. And thanks for the article reference. That was very helpful. I am sure we are all guilty of a little bias in our decision making. But I would say that on balance, we do less harm than our medical counterparts when it comes to diagnosing and treating patients.A year ago I attended one of many Pain Society of Oregon meetings where they were having a panel discussion about some difficult cases one of the neurologists in the group had brought to discuss. The first case was a women in her 50's who had been suffering from severe debilitating head pain. Many drugs had been tried over the years - mostly opiates. When that failed, they decided to remove part of her BRAIN - no change. They turned to the acupuncturist and chiropractor on the panel to discuss treatment options. Both discussed how they might begin to work with this individual. The main point not made was that chiropractic and acupuncture should have been tried BEFORE taking part of this poor woman's brain out and they created a severe depletion of neurotransmitters, hormone imbalances and God know what else. Most of us see this side of the story too often, and I think accounts for some of our zealous behavior. You have seen the other side. It is inexcusable, and we should all be honest about our patient's options and make certain that they are consenting and knowledgeable. Not everyone wants what we have to offer. If they are not on board, they should be given a choice of alternatives - with your professional "take" on what you think is best for their health. But most of us have seen countless patients who have been held "hostage" by biased medical practitioners. Patients who say, "I don't know why my MD thought you were going to paralyze me, this is the best thing I have ever done for my health! I am so happy my friend/loved one talked me into seeing you."Jay Lindekugel, DCConcordia Chiropractic and Movement Center From: Sharron Fuchs <sharronf@tdinjuryla w.com>@grou ps.comSent: Friday, November 7, 2008 11:04:29 AMSubject: RE: Fw: LBP case... follow up2Of course. They need to wake up too to what can be a legitimate option for the patient. We have to be smarter. We also have to accept the idea and even admit that there are risks to our treatments also. s. fuchs From: @grou ps.com [mailto:] On Behalf Of SeitzSent: Friday, November 07, 2008 11:02 AM@grou ps.comSubject: RE: Fw: LBP case... follow up2 Of course the flip-side to this is the very common bias against what chiropractors do by the medical profession, especially when related to manual adjusting of the upper cervical spine. Seitz, DC From: @grou ps.com [mailto:] On Behalf Of Sharron FuchsSent: Friday, November 07, 2008 10:35 AMSubject: RE: Fw: LBP case... follow up2 Only the patient can make the determination of their pain level and what options they wish to try for relief. I don’t think it is up to us to bias them about all the negatives when in some cases it might be of great benefit. I know you know that. I don’t want to argue about it but this is a sensitive point for me as I was posting in the past about a 90 year old person who was suffering terribly and the DC that was treating them essentially held them hostage in their pain to their bias. It was abuse in my mind and I think we need to consider all things that might help the benefit as we practice to the standard of providing adequate pain relief. s. fuchs dc From: @grou ps.com [mailto:] On Behalf Of joe medlinSent: Friday, November 07, 2008 10:22 AM Lindekugel; Marc Heller; glenntamearthlink (DOT) net ; W. Pfeiffer , DCCc: Subject: Re: Fw: LBP case... follow up2  Despite the fact that the risks may be remote, it's advisable for a patients to understand that arachnoiditis, nerve root damage, infection etc. are inherant risks. Not to mention the damage the steroid does to the rest of the body. Theres a reason they only allow 3/year. They only help about 50% and thats only temporary. THey should be reserved for extreme cases of stenosis in my opinion not a mild bulge such as we see in this case. An argument can also be made that it will slow healing time down in the long run. ph Medlin D.C.Spine Tree Chiropractic1607 NE Alberta St . PDX, OR 97211www.spinetreepdx. com* Re: LBP case>> > >> > I have a 52yr old male (desk worker) with severe> LBP(8/10 VAS),> gradual onset over the coarse of a few hours, about 2> weeks ago.> Pain levels have been increasing, and now he is also> getting a "numb> feeling" into his anterior left thigh, medial knee and medial> proximal calf. His only position of relief for LBP is> squatting.> Can't find relief for the numbness.> >> > exam: Initially neuro exam was negative but now loss> (0/2) of> Patella reflex on left. Sensation still intact, Lower> extremity str> all +5/5, except iliopsoas +3/5 due to local LBP, heel and> toe walk> neg. SLR/SLR max both neg. Kemps neg. Stretching of> iliopsoas or> piriformis gave an immediate relief of symptoms (1/10 VAS)> >> > I have done 3 treatments consisting of massage, stretch> of affected> muscles, microcurrent, and side posture manual adjustment.> Home> stretches were assigned. We also have a naturopath and an> acupuncturist in our office and he received acupuncture as> well as> Trameel injections into the piriformis. Each treatment> helped for a> few days. Before symptoms would return, and worse than> before. Home> stretching only gives small and temporary relief.> >> > Due to appearance of neuro finding I sent him for a MRI:> > finding: mild bulge with a small annular tear L4-5> >> > First any ideas for annular tears.> >> > Second, I am fairly confident that the leg numbness is a> parathesia> and is referred from the muscle spasm and not due to nerve> root> impingement. Due to the fact I am able to reduce the> numbness and> back pain with in-office stretching, SLR max is negative and> adjusting helps so dramatically and quickly.> >> > However I am concerned about the loss of patellar> reflex, and the> patient is concerned about long term neurological> ramifications, so> does anyone have a good neuro referral in the East side of> Portland .> >> > thank you all in advance.> >> > Glenn Sykes, DC> > Gresham/Newberg, Oregon> > 503-550-8806> >Don't give up to soon. Ultrasound right over the piriformis> (O,I,Belly)everytim e and stretching to release it will> help. Getting> the inflamation down in the piriformis is critical. I have> seen the> reflexes come back to normal in two to three weeks.>> Brad Rethwill , DC> Eugene , OR>> > ------------ --------- --------- --------- --------- --------- ->>> No virus found in this incoming message.> Checked by AVG - http://www.avg. com > Version: 8.0.175 / Virus Database: 270.8.6/1768 - Release Date: 11/4/2008 9:38 PM>> ------------ --------- --------- ------All posts must adhere to OregonDCs rules located on homepage at: http://groups. / group//Tell a colleague about OregonDCs! (must be licensed Oregon DC )

[Guest guest]

‘Cut , Burn and Poison’ , was that an

AC/DC song? 

But seriously, that is what medicine does,

which is necessary sometimes.  I work in an interdisciplinary setting, I’m not

anti-medicine, but that doesn’t mean I’m pro-drug.  Medicine/Drugs have their

place but what do antibiotics do?  They kill, what does surgery do?  Remove or

repair but not provide “healthâ€.  Poison? What is chemo-therapy?  If needed,

use it, but other, less aggressive methods (and even earlier, a focus on

wellness) is often better.  But what does the public hear from advertisements? 

Drugs = Health!  What does the family doc offer, wellness care, conservative

care or pharmaceutical care?  Generally the latter.  And very infrequently do

they recommend DC care!  I know there are exceptions but that is the general

rule.  I am sure there are DC’s who consistently bad mouth MD’s but I don’t. 

But I do tell my patients that MD’s are trained in diagnose and drugs and often

don’t understand the benefit of other alternatives.

Seitz, DC

From:

[mailto: ] On Behalf Of Sharron Fuchs

Sent: Monday, November 10, 2008

11:11 AM

Subject: RE: Fw:

LBP case... follow up2

I often read commentary on this list serve that is outright basing

of the medical profession. I am a DC. A DC commenting on DC care is

intraprofessional critique which is what we should do more of. We know little

or nothing about the medical profession and they know little or nothing about

us. If we keep the focus on us we can improve and expand our knowledge and

view.

‘Cut , Burn and Poison’ was the mantra spewed at WSCC when I was

there. I hear it used by DC’s still.

s. fuchs dc

From: Lindekugel [mailto:pdxchiroguy ]

Sent: Friday, November 07, 2008

5:24 PM

Sharron Fuchs;

Subject: Re: Fw:

LBP case... follow up2

I guess that is

just it. I don't see anybody saying ‘You hear me Darla, all MD’s are nothing but cut, burn and poison.

There is nothing they do or say that can help you. Only I can help

you………………….’.

Who is doing

this? Is this what you think we are saying to our patients? I think

the comments below and discussing the dangers (namely backed by numbers) is

just what we are supposed to be aware of as responsible physicians. This

is not MD bashing any more than you sharing your encounter with the

chiropractor and the 90 year old was chiro-bashing.

Jay

Lindekugel, DC

Concordia

Chiropractic Center

From: Sharron Fuchs <sharronftdinjurylaw>

Lindekugel

<pdxchiroguy >;

Sent: Friday, November 7, 2008

4:19:21 PM

Subject: RE: Fw:

LBP case... follow up2

You know darn well that is not what I mean. Bad mouth = ‘You hear

me Darla, all MD’s are nothing but cut, burn and poison. There is nothing they

do or say that can help you. Only I can help you………………….’

s. fuchs dc

From: Lindekugel [mailto:pdxchiroguy ]

Sent: Friday, November 07, 2008

4:13 PM

Sharron Fuchs;

Subject: Re: Fw:

LBP case... follow up2

If by " bad mouth " you mean explaining to patients faced

with difficult decisions the importance of weighing the risk benefit ratio of

different procedures - including chiropractic -

.... ...guilty as charged.

Jay

Lindekugel, DC

Concordia

Chiropractic Center

From: Sharron Fuchs <sharronftdinjurylaw>

Sent: Friday, November 7, 2008

2:36:44 PM

Subject: RE: Fw:

LBP case... follow up2

Yes, there are many stories to go around. For us, I think we

should not bad mouth others but rather seek ways for us to improve what we do.

s. fuchs dc

From: Lindekugel [mailto:pdxchiroguy @]

Sent: Friday, November 07, 2008

1:55 PM

Sharron Fuchs;

@grou ps.com

Subject: Re: Fw:

LBP case... follow up2

Agreed. And

thanks for the article reference. That was very helpful. I am sure we are

all guilty of a little bias in our decision making. But I would say that

on balance, we do less harm than our medical counterparts when it comes to diagnosing

and treating patients.

A year ago I attended one of many Pain Society of Oregon meetings where they

were having a panel discussion about some difficult cases one of the

neurologists in the group had brought to discuss. The first case was a

women in her 50's who had been suffering from severe debilitating head

pain. Many drugs had been tried over the years - mostly opiates.

When that failed, they decided to remove part of her BRAIN - no change.

They turned to the acupuncturist and chiropractor on the panel to discuss

treatment options. Both discussed how they might begin to work with this

individual. The main point not made was that chiropractic and acupuncture

should have been tried BEFORE taking part of this poor woman's brain out and

they created a severe depletion of neurotransmitters, hormone imbalances and

God know what else.

Most of us see this side of the story too often, and I think accounts for some

of our zealous behavior. You have seen the other side. It is

inexcusable, and we should all be honest about our patient's options and make

certain that they are consenting and knowledgeable.

Not everyone wants what we have to offer. If they are not on board, they

should be given a choice of alternatives - with your professional

" take " on what you think is best for their health. But most of

us have seen countless patients who have been held " hostage " by

biased medical practitioners. Patients who say, " I don't know why my

MD thought you were going to paralyze me, this is the best thing I have ever done

for my health! I am so happy my friend/loved one talked me into seeing

you. "

Jay

Lindekugel, DC

Concordia Chiropractic and Movement

Center

From: Sharron Fuchs <sharronf@tdinjuryla w.com>

@grou ps.com

Sent: Friday, November 7, 2008

11:04:29 AM

Subject: RE: Fw:

LBP case... follow up2

Of course. They need to wake up too to what can be a legitimate

option for the patient. We have to be smarter. We also have to accept the idea

and even admit that there are risks to our treatments also.

s. fuchs

From: @grou ps.com [mailto:] On Behalf Of Seitz

Sent: Friday, November 07, 2008

11:02 AM

@grou ps.com

Subject: RE: Fw:

LBP case... follow up2

Of course the flip-side to this is the very common bias against

what chiropractors do by the medical profession, especially when related to

manual adjusting of the upper cervical spine.

Seitz, DC

From: @grou ps.com [mailto:@

groups. com] On Behalf Of Sharron

Fuchs

Sent: Friday, November 07, 2008

10:35 AM

Subject: RE: Fw:

LBP case... follow up2

Only the patient can make the determination of their pain level and

what options they wish to try for relief. I don’t think it is up to us to bias

them about all the negatives when in some cases it might be of great benefit. I

know you know that. I don’t want to argue about it but this is a sensitive

point for me as I was posting in the past about a 90 year old person who was

suffering terribly and the DC that was treating them essentially held them

hostage in their pain to their bias. It was abuse in my mind and I think we

need to consider all things that might help the benefit as we practice to the

standard of providing adequate pain relief.

s. fuchs dc

From: @grou ps.com [mailto:@

groups. com] On Behalf Of joe

medlin

Sent: Friday, November 07, 2008

10:22 AM

Lindekugel; Marc Heller;

glenntamearthlink (DOT) net ; W. Pfeiffer , DC

Cc:

Subject: Re: Fw:

LBP case... follow up2



Despite the fact

that the risks may be remote, it's advisable for a patients to understand that

arachnoiditis, nerve root damage, infection etc. are inherant risks. Not to

mention the damage the steroid does to the rest of the body. Theres a reason

they only allow 3/year. They only help about 50% and thats only

temporary. THey should be reserved for extreme cases of stenosis in my

opinion not a mild bulge such as we see in this case. An argument can also be

made that it will slow healing time down in the long run.

ph Medlin D.C.

Spine Tree Chiropractic

1607 NE Alberta St

..

PDX, OR 97211

www.spinetreepdx. com

-----

Original Message -----

From:

Lindekugel

joe

medlin ; Marc

Heller ; glenntamearthlink (DOT)

net ; W.

Pfeiffer, DC

Cc:

Sent: Friday, November 07, 2008 9:01 AM

Subject: Re: Fw: LBP case... follow up2

Do any of you have

good statistics on the prevalence of acute arachnoiditis with this

procedure? It would be helpful for patients who are weighing the

risk/benefit ratio.

Jay

Lindekugel, DC

Concordia

Chiropractic Center

5425 NE 33rd Ave.

From: joe medlin <spinetree@qwestoffi ce.net>

Marc Heller <mheller@marchellerd c.com>; glenntamearthlink (DOT) net;

" W. Pfeiffer

, DC " <drboboregontrail (DOT) net>

Cc: <@grou ps.com>

Sent: Thursday, November 6, 2008

6:29:48 PM

Subject: Re: Fw:

LBP case... follow up2



I was hoping i

wasn't the only one who thought that was invasive. These cases can be very

effectively treated via standard chiropractic treatment.

ph Medlin D.C.

Spine Tree Chiropractic

1607 NE Alberta St

..

PDX, OR 97211

www.spinetreepdx. com

-----

Original Message -----

From: W.

Pfeiffer, DC

'Marc

Heller' ; glenntamearthlink (DOT)

net

Cc: ''

Sent: Thursday, November 06, 2008 5:36 PM

Subject: RE: Fw: LBP case... follow up2

Hi Marc

Are epidural injections worth the risk of acute arachnoiditis? ??

Bob

W. Pfeiffer

, DC , DABCO

P. O. Box

606

Pendleton Or 97801

541-276-2550

Re: Re: LBP case

>

> Excuse my ignorance, but Trameel injections?? ?

>

> Sounds to me like the n. root is the main culprit of pain

> referral especially with reflex loss and Spasm etc. is most

> likely the cause of that irritation. It is curious that he

> gets relief from stretching etc, but with a mild bulge many

> times the symptoms aren't as constant and clear as a full on

> herniation. In my opinion i'd also be sure to be very gentle

> with stretching in order to not irritate the nerve and

> gradually increase intensity. As you know a mild bulge will

> relent much faster than a herniation so treat and monitor.

>

> me 2 cents on this wonderful Obama morning,,,,, ,,

> sorry, couldnt resist.

>

> ph Medlin D.C.

> Spine Tree Chiropractic

> 1607 NE Alberta St

..

> PDX, OR 97211

> www.spinetreepdx. com <http://www.spinetre epdx.com>

>

> * Re: LBP case

>

>

> >

> > I have a 52yr old male (desk worker) with severe

> LBP(8/10 VAS),

> gradual onset over the coarse of a few hours, about 2

> weeks ago.

> Pain levels have been increasing, and now he is also

> getting a " numb

> feeling " into his anterior left thigh, medial knee and medial

> proximal calf. His only position of relief for LBP is

> squatting.

> Can't find relief for the numbness.

> >

> > exam: Initially neuro exam was negative but now loss

> (0/2) of

> Patella reflex on left. Sensation still intact, Lower

> extremity str

> all +5/5, except iliopsoas +3/5 due to local LBP, heel and

> toe walk

> neg. SLR/SLR max both neg. Kemps neg. Stretching of

> iliopsoas or

> piriformis gave an immediate relief of symptoms (1/10 VAS)

> >

> > I have done 3 treatments consisting of massage, stretch

> of affected

> muscles, microcurrent, and side posture manual adjustment.

> Home

> stretches were assigned. We also have a naturopath and an

> acupuncturist in our office and he received acupuncture as

> well as

> Trameel injections into the piriformis. Each treatment

> helped for a

> few days. Before symptoms would return, and worse than

> before. Home

> stretching only gives small and temporary relief.

> >

> > Due to appearance of neuro finding I sent him for a MRI:

> > finding: mild bulge with a small annular tear L4-5

> >

> > First any ideas for annular tears.

> >

> > Second, I am fairly confident that the leg numbness is a

> parathesia

> and is referred from the muscle spasm and not due to nerve

> root

> impingement. Due to the fact I am able to reduce the

> numbness and

> back pain with in-office stretching, SLR max is negative and

> adjusting helps so dramatically and quickly.

> >

> > However I am concerned about the loss of patellar

> reflex, and the

> patient is concerned about long term neurological

> ramifications, so

> does anyone have a good neuro referral in the East side of

> Portland

..

> >

> > thank you all in advance.

> >

> > Glenn Sykes, DC

> > Gresham/Newberg, Oregon

> > 503-550-8806

> >Don't give up to soon. Ultrasound right over the piriformis

> (O,I,Belly)everytim e and stretching to release it will

> help. Getting

> the inflamation down in the piriformis is critical. I have

> seen the

> reflexes come back to normal in two to three weeks.

>

> Brad Rethwill

, DC

> Eugene

, OR

>

>

> ------------ --------- --------- --------- --------- --------- -

>

>

> No virus found in this incoming message.

> Checked by AVG - http://www.avg.

com

> Version: 8.0.175 / Virus Database: 270.8.6/1768 - Release Date: 11/4/2008

9:38 PM

>

>

------------ --------- --------- ------

All posts must adhere to OregonDCs rules located on homepage at: http://groups.

/ group//

Tell a colleague about OregonDCs! (must be licensed Oregon DC

)

[Guest guest]

I suppose you could look at it : Antibiotics at times ‘kill’ to obtainhealth because in the absence of it it could mean death.Surgery removes diseased tissue at timesfor health because without it it could mean death.Chemo-therapy poisons (kills) diseasedtissue at times for health because without it it could mean death. Other professions need to know that ourcare too can be used for health. That is our job to inform them. What studies are out there showing thatour care , or other alternative care improves health ? That would be a goodmarketing/informing tool. s. fuchs dcFrom: [mailto: ] On Behalf Of SeitzSent: Monday, November 10, 20083:16 PM Subject: RE: Fw:LBP case... follow up2 ‘Cut , Burn and Poison’ , was that an AC/DC song? But seriously, that is what medicine does, which is necessarysometimes. I work in an interdisciplinary setting, I’m not anti-medicine,but that doesn’t mean I’m pro-drug. Medicine/Drugs have their place butwhat do antibiotics do? They kill, what does surgery do? Remove orrepair but not provide “healthâ€. Poison? What is chemo-therapy? Ifneeded, use it, but other, less aggressive methods (and even earlier, a focuson wellness) is often better. But what does the public hear fromadvertisements? Drugs = Health! What does the family doc offer,wellness care, conservative care or pharmaceutical care? Generally thelatter. And very infrequently do they recommend DC care! I knowthere are exceptions but that is the general rule. I am sure there areDC’s who consistently bad mouth MD’s but I don’t. But I do tell mypatients that MD’s are trained in diagnose and drugs and often don’t understandthe benefit of other alternatives. Seitz, DC From: [mailto: ]On Behalf Of Sharron FuchsSent: Monday, November 10, 2008 11:11AM Subject: RE: Fw:LBP case... follow up2 I often read commentary on this list serve that is outright basingof the medical profession. I am a DC. A DC commenting on DC care is intraprofessionalcritique which is what we should do more of. We know little or nothing aboutthe medical profession and they know little or nothing about us. If we keep thefocus on us we can improve and expand our knowledge and view. ‘Cut , Burn and Poison’ was the mantra spewed at WSCC when I wasthere. I hear it used by DC’s still. s. fuchs dc From: Lindekugel [mailto:pdxchiroguy ]Sent: Friday, November 07, 20085:24 PMSharron Fuchs; Subject: Re: Fw:LBP case... follow up2 I guess that isjust it. I don't see anybody saying ‘You hear me Darla, all MD’s are nothing but cut, burn and poison.There is nothing they do or say that can help you. Only I can helpyou………………….’. Who is doingthis? Is this what you think we are saying to our patients? I thinkthe comments below and discussing the dangers (namely backed by numbers) isjust what we are supposed to be aware of as responsible physicians. Thisis not MD bashing any more than you sharing your encounter with thechiropractor and the 90 year old was chiro-bashing.Jay Lindekugel, DCConcordiaChiropractic CenterFrom: Sharron Fuchs <sharronftdinjurylaw> Lindekugel<pdxchiroguy >; Sent: Friday, November 7, 20084:19:21 PMSubject: RE: Fw:LBP case... follow up2You know darn well that is not what I mean. Bad mouth = ‘You hearme Darla, all MD’s are nothing but cut, burn and poison. There is nothing they door say that can help you. Only I can help you………………….’ s. fuchs dc From: Lindekugel [mailto:pdxchiroguy ]Sent: Friday, November 07, 20084:13 PMSharron Fuchs; Subject: Re: Fw:LBP case... follow up2 If by " bad mouth " you mean explaining to patients facedwith difficult decisions the importance of weighing the risk benefit ratio ofdifferent procedures - including chiropractic -... ...guilty as charged.Jay Lindekugel, DCConcordiaChiropractic Center From: Sharron Fuchs <sharronftdinjurylaw> Sent: Friday, November 7, 20082:36:44 PMSubject: RE: Fw:LBP case... follow up2 Yes, there are many stories to go around. For us, I think weshould not bad mouth others but rather seek ways for us to improve what we do. s. fuchs dc From: Lindekugel [mailto:pdxchiroguy @] Sent: Friday, November 07, 20081:55 PMSharron Fuchs;@grou ps.comSubject: Re: Fw:LBP case... follow up2 Agreed. Andthanks for the article reference. That was very helpful. I am sure we areall guilty of a little bias in our decision making. But I would say thaton balance, we do less harm than our medical counterparts when it comes todiagnosing and treating patients.A year ago I attended one of many Pain Society of Oregon meetings where theywere having a panel discussion about some difficult cases one of theneurologists in the group had brought to discuss. The first case was awomen in her 50's who had been suffering from severe debilitating headpain. Many drugs had been tried over the years - mostly opiates. When that failed, they decided to remove part of her BRAIN - no change. They turned to the acupuncturist and chiropractor on the panel to discusstreatment options. Both discussed how they might begin to work with thisindividual. The main point not made was that chiropractic and acupunctureshould have been tried BEFORE taking part of this poor woman's brain out andthey created a severe depletion of neurotransmitters, hormone imbalances andGod know what else. Most of us see this side of the story too often, and I think accounts for someof our zealous behavior. You have seen the other side. It isinexcusable, and we should all be honest about our patient's options and makecertain that they are consenting and knowledgeable. Not everyone wants what we have to offer. If they are not on board, theyshould be given a choice of alternatives - with your professional " take " on what you think is best for their health. But most ofus have seen countless patients who have been held " hostage " bybiased medical practitioners. Patients who say, " I don't know why myMD thought you were going to paralyze me, this is the best thing I have everdone for my health! I am so happy my friend/loved one talked me intoseeing you. " Jay Lindekugel, DCConcordia Chiropractic and Movement Center From: Sharron Fuchs <sharronf@tdinjuryla w.com>@grou ps.comSent: Friday, November 7, 200811:04:29 AMSubject: RE: Fw:LBP case... follow up2Of course. They need to wake up too to what can be a legitimateoption for the patient. We have to be smarter. We also have to accept the ideaand even admit that there are risks to our treatments also. s. fuchs From: @grou ps.com [mailto:] On Behalf Of SeitzSent: Friday, November 07, 200811:02 AM@grou ps.comSubject: RE: Fw:LBP case... follow up2 Of course the flip-side to this is the very common bias againstwhat chiropractors do by the medical profession, especially when related tomanual adjusting of the upper cervical spine. Seitz, DC From: @grou ps.com [mailto:groups (DOT) com] On Behalf Of SharronFuchsSent: Friday, November 07, 200810:35 AMSubject: RE: Fw:LBP case... follow up2 Only the patient can make the determination of their pain level andwhat options they wish to try for relief. I don’t think it is up to us to biasthem about all the negatives when in some cases it might be of great benefit. Iknow you know that. I don’t want to argue about it but this is a sensitivepoint for me as I was posting in the past about a 90 year old person who wassuffering terribly and the DC that was treating them essentially held themhostage in their pain to their bias. It was abuse in my mind and I think weneed to consider all things that might help the benefit as we practice to thestandard of providing adequate pain relief. s. fuchs dc From: @grou ps.com [mailto:groups (DOT) com] On Behalf Of joemedlinSent: Friday, November 07, 200810:22 AM Lindekugel; Marc Heller;glenntamearthlink (DOT) net ; W. Pfeiffer , DCCc: Subject: Re: Fw:LBP case... follow up2  Despite the factthat the risks may be remote, it's advisable for a patients to understand thatarachnoiditis, nerve root damage, infection etc. are inherant risks. Not tomention the damage the steroid does to the rest of the body. Theres a reasonthey only allow 3/year. They only help about 50% and thats onlytemporary. THey should be reserved for extreme cases of stenosis in my opinionnot a mild bulge such as we see in this case. An argument can also be made thatit will slow healing time down in the long run. ph Medlin D.C.Spine Tree Chiropractic1607 NEAlberta St . PDX, OR 97211www.spinetreepdx. com Re: Re: LBP case>> Excuse my ignorance, but Trameel injections?? ?> > Sounds to me like the n. root is the main culprit of pain> referral especially with reflex loss and Spasm etc. is most> likely the cause of that irritation. It is curious that he > gets relief from stretching etc, but with a mild bulge many> times the symptoms aren't as constant and clear as a full on> herniation. In my opinion i'd also be sure to be very gentle> with stretching in order to not irritate the nerve and> gradually increase intensity. As you know a mild bulge will> relent much faster than a herniation so treat and monitor.> > me 2 cents on this wonderful Obama morning,,,,, ,,> sorry, couldnt resist.> > ph Medlin D.C.> Spine Tree Chiropractic> 1607 NEAlberta St .> PDX, OR 97211> www.spinetreepdx. com <http://www.spinetre epdx.com>>> * Re: LBP case>> > >> > I have a 52yr old male (desk worker) with severe> LBP(8/10 VAS),> gradual onset over the coarse of a few hours, about 2> weeks ago.> Pain levels have been increasing, and now he is also> getting a " numb> feeling " into his anterior left thigh, medial knee and medial> proximal calf. His only position of relief for LBP is> squatting.> Can't find relief for the numbness.> >> > exam: Initially neuro exam was negative but now loss> (0/2) of> Patella reflex on left. Sensation still intact, Lower> extremity str> all +5/5, except iliopsoas +3/5 due to local LBP, heel and> toe walk> neg. SLR/SLR max both neg. Kemps neg. Stretching of> iliopsoas or> piriformis gave an immediate relief of symptoms (1/10 VAS)> >> > I have done 3 treatments consisting of massage, stretch> of affected> muscles, microcurrent, and side posture manual adjustment.> Home> stretches were assigned. We also have a naturopath and an> acupuncturist in our office and he received acupuncture as> well as> Trameel injections into the piriformis. Each treatment> helped for a> few days. Before symptoms would return, and worse than> before. Home> stretching only gives small and temporary relief.> >> > Due to appearance of neuro finding I sent him for a MRI:> > finding: mild bulge with a small annular tear L4-5> >> > First any ideas for annular tears.> >> > Second, I am fairly confident that the leg numbness is a> parathesia> and is referred from the muscle spasm and not due to nerve> root> impingement. Due to the fact I am able to reduce the> numbness and> back pain with in-office stretching, SLR max is negative and> adjusting helps so dramatically and quickly.> >> > However I am concerned about the loss of patellar> reflex, and the> patient is concerned about long term neurological> ramifications, so> does anyone have a good neuro referral in the East side of> Portland.> >> > thank you all in advance.> >> > Glenn Sykes, DC> > Gresham/Newberg, Oregon> > 503-550-8806> >Don't give up to soon. Ultrasound right over the piriformis> (O,I,Belly)everytim e and stretching to release it will> help. Getting> the inflamation down in the piriformis is critical. I have> seen the> reflexes come back to normal in two to three weeks.>> Brad Rethwill, DC> Eugene, OR>> > ------------ --------- --------- --------- --------- --------- ->>> No virus found in this incoming message.> Checked by AVG - http://www.avg.com > Version: 8.0.175 / Virus Database: 270.8.6/1768 - Release Date: 11/4/20089:38 PM>> ------------ --------- --------- ------All posts must adhere to OregonDCs rules located on homepage at: group//Tell a colleague about OregonDCs! (must be licensed Oregon DC )Links

[Guest guest]



Sharron,

MD's have tried to squash our profession from the beginning. Many of them continue to badmouth our profession at every turn and it's VERRY easy to find one that has said something derrogatory about our profession to a patient.

On the other hand, it's pretty rare to hear a story of a chiropractor telling a patient that they should NOT see an MD because they will hurt them etc. Does it happen? Yes, but not nearly as often

THe scales arent' even. Sure there are exceptions, but the fact of the matter is that the medical profession in general is the one that doesn't appreciate or understand what WE do not the other way around.

I'm not sure that it's entirely our job to inform them. Chiro has been around for a 100 years, patients swear by us, and all you have to do is look it up. Come on these are Doctors. They aint stooopid. Sure we need to do our part in speaking with them, but the ones that know about us didn't necessarily come to that knowledge by a sit down with a chiropractor. The ones who don't know what we do, practically choose not to at this point.

ph Medlin D.C.Spine Tree Chiropractic1607 NE Alberta St. PDX, OR 97211www.spinetreepdx.com

* Re: LBP case>> > >> > I have a 52yr old male (desk worker) with severe> LBP(8/10 VAS),> gradual onset over the coarse of a few hours, about 2> weeks ago.> Pain levels have been increasing, and now he is also> getting a "numb> feeling" into his anterior left thigh, medial knee and medial> proximal calf. His only position of relief for LBP is> squatting.> Can't find relief for the numbness.> >> > exam: Initially neuro exam was negative but now loss> (0/2) of> Patella reflex on left. Sensation still intact, Lower> extremity str> all +5/5, except iliopsoas +3/5 due to local LBP, heel and> toe walk> neg. SLR/SLR max both neg. Kemps neg. Stretching of> iliopsoas or> piriformis gave an immediate relief of symptoms (1/10 VAS)> >> > I have done 3 treatments consisting of massage, stretch> of affected> muscles, microcurrent, and side posture manual adjustment.> Home> stretches were assigned. We also have a naturopath and an> acupuncturist in our office and he received acupuncture as> well as> Trameel injections into the piriformis. Each treatment> helped for a> few days. Before symptoms would return, and worse than> before. Home> stretching only gives small and temporary relief.> >> > Due to appearance of neuro finding I sent him for a MRI:> > finding: mild bulge with a small annular tear L4-5> >> > First any ideas for annular tears.> >> > Second, I am fairly confident that the leg numbness is a> parathesia> and is referred from the muscle spasm and not due to nerve> root> impingement. Due to the fact I am able to reduce the> numbness and> back pain with in-office stretching, SLR max is negative and> adjusting helps so dramatically and quickly.> >> > However I am concerned about the loss of patellar> reflex, and the> patient is concerned about long term neurological> ramifications, so> does anyone have a good neuro referral in the East side of> Portland .> >> > thank you all in advance.> >> > Glenn Sykes, DC> > Gresham/Newberg, Oregon> > 503-550-8806> >Don't give up to soon. Ultrasound right over the piriformis> (O,I,Belly)everytim e and stretching to release it will> help. Getting> the inflamation down in the piriformis is critical. I have> seen the> reflexes come back to normal in two to three weeks.>> Brad Rethwill , DC> Eugene , OR>> > ------------ --------- --------- --------- --------- --------- ->>> No virus found in this incoming message.> Checked by AVG - http://www.avg. com > Version: 8.0.175 / Virus Database: 270.8.6/1768 - Release Date: 11/4/2008 9:38 PM>> ------------ --------- --------- ------All posts must adhere to OregonDCs rules located on homepage at: http://groups. / group//Tell a colleague about OregonDCs! (must be licensed Oregon DC )

[Guest guest]

"We

know little or nothing about the medical profession and they know little or

nothing about us." You gotta be joking here, right?! Most of us were brought up in the medical system. If you had graduated from WSCC in the late 90's you would have received - largely - a medical education focused on manual medicine, labratory diagnosis and chiropractic. Very few of our friends in medicine have entered a chiropractors office. Very few are familiar with the hundreds of research articles on chiropractic. Even when Osteopaths make the case for osteiopathic manipulation, they use 75% chiropractic research to back it up. Further, my 11th quarter at WSCC, my clinician and myself went up on the hill to demonstrate chiropractic during the family medicine rounds. They thought we were the most professional "witch doctors" they had ever seen. You can learn a lot from someone by the questions they ask. What I learned was that they had no idea what a chiropractor was. I am

sure that has improved some over the last 8 years.I would say that they know VERY little about us, but we know a lot about them.Yet we still do research at our clinic, and I make the effort every hour to inform my patients and their PCP, what we do. It is getting better.Jay Lindekugel, DCConcordia Chiropractic Center From: Sharron Fuchs <sharronf@...> Sent: Monday, November 10, 2008 11:10:37

AMSubject: RE: Fw: LBP case... follow up2

I often read commentary on this list serve

that is outright basing of the medical profession. I am a DC. A DC commenting

on DC care is intraprofessional critique which is what we should do more of. We

know little or nothing about the medical profession and they know little or

nothing about us. If we keep the focus on us we can improve and expand our

knowledge and view. ‘Cut , Burn and Poison’ was the mantra

spewed at WSCC when I was there. I hear it used by DC’s still. s. fuchs dc

From: Lindekugel

[mailto:pdxchiroguy @]

Sent: Friday, November 07, 2008

5:24 PM

Sharron Fuchs;

@grou ps.com

Subject: Re: Fw:

LBP case... follow up2

I guess that is just it. I don't see anybody saying ‘You hear me Darla, all MD’s are nothing but cut, burn and poison.

There is nothing they do or say that can help you. Only I can help

you………………….’.

Who is doing this?

Is this what you think we are saying to our patients? I think the

comments below and discussing the dangers (namely backed by numbers) is just

what we are supposed to be aware of as responsible physicians. This is

not MD bashing any more than you sharing your encounter with the

chiropractor and the 90 year old was chiro-bashing.

Jay

Lindekugel, DC

Concordia Chiropractic Center

From: Sharron

Fuchs <sharronf@tdinjuryla w.com>

Lindekugel

<pdxchiroguy>; @grou ps.com

Sent: Friday, November 7, 2008

4:19:21 PM

Subject: RE: Fw:

LBP case... follow up2

You know darn well that is not what I

mean. Bad mouth = ‘You hear me Darla, all MD’s are nothing but cut, burn and

poison. There is nothing they do or say that can help you. Only I can help

you………………….’ s. fuchs dc

From: Lindekugel

[mailto:pdxchiroguy @]

Sent: Friday, November 07, 2008

4:13 PM

Sharron Fuchs;

@grou ps.com

Subject: Re: Fw:

LBP case... follow up2

If by "bad mouth" you mean

explaining to patients faced with difficult decisions the importance of

weighing the risk benefit ratio of different procedures - including

chiropractic - ... ...guilty as

charged.

Jay

Lindekugel, DC

Concordia Chiropractic Center

From: Sharron

Fuchs <sharronf@tdinjuryla w.com>

@grou ps.com

Sent: Friday, November 7, 2008

2:36:44 PM

Subject: RE: Fw:

LBP case... follow up2

Yes, there are many stories to go

around. For us, I think we should not bad mouth others but rather seek ways for

us to improve what we do. s. fuchs dc

From: Lindekugel

[mailto:pdxchiroguy @]

Sent: Friday, November 07, 2008

1:55 PM

Sharron Fuchs;

@grou ps.com

Subject: Re: Fw:

LBP case... follow up2

Agreed. And thanks for the article reference. That was very

helpful. I am sure we are all guilty of a little bias in our decision

making. But I would say that on balance, we do less harm than our medical

counterparts when it comes to diagnosing and treating patients.

A year ago I attended one of many Pain Society of Oregon meetings where they

were having a panel discussion about some difficult cases one of the

neurologists in the group had brought to discuss. The first case was a

women in her 50's who had been suffering from severe debilitating head

pain. Many drugs had been tried over the years - mostly opiates.

When that failed, they decided to remove part of her BRAIN - no change. They

turned to the acupuncturist and chiropractor on the panel to discuss treatment

options. Both discussed how they might begin to work with this

individual. The main point not made was that chiropractic and acupuncture

should have been tried BEFORE taking part of this poor woman's brain out and

they created a severe depletion of neurotransmitters, hormone imbalances and

God know what else.

Most of us see this side of the story too often, and I think accounts for some

of our zealous behavior. You have seen the other side. It is

inexcusable, and we should all be honest about our patient's options and make

certain that they are consenting and knowledgeable.

Not everyone wants what we have to offer. If they are not on board, they

should be given a choice of alternatives - with your professional

"take" on what you think is best for their health. But most of

us have seen countless patients who have been held "hostage" by

biased medical practitioners. Patients who say, "I don't know why my

MD thought you were going to paralyze me, this is the best thing I have ever

done for my health! I am so happy my friend/loved one talked me into

seeing you."

Jay

Lindekugel, DC

Concordia Chiropractic and Movement Center

From: Sharron

Fuchs <sharronf@tdinjuryla w.com>

@grou ps.com

Sent: Friday, November 7, 2008

11:04:29 AM

Subject: RE: Fw:

LBP case... follow up2

Of course. They need to wake up too to

what can be a legitimate option for the patient. We have to be smarter. We also

have to accept the idea and even admit that there are risks to our treatments

also. s. fuchs

From:

@grou ps.com

[mailto:] On

Behalf Of Seitz

Sent: Friday, November 07, 2008

11:02 AM

@grou ps.com

Subject: RE: Fw:

LBP case... follow up2

Of course the flip-side to this is the

very common bias against what chiropractors do by the medical profession, especially

when related to manual adjusting of the upper cervical spine. Seitz, DC

From:

@grou ps.com [mailto:] On Behalf Of Sharron Fuchs

Sent: Friday, November 07, 2008

10:35 AM

Subject: RE: Fw:

LBP case... follow up2

Only the patient can make the

determination of their pain level and what options they wish to try for relief.

I don’t think it is up to us to bias them about all the negatives when in some

cases it might be of great benefit. I know you know that. I don’t want to argue

about it but this is a sensitive point for me as I was posting in the past

about a 90 year old person who was suffering terribly and the DC that was

treating them essentially held them hostage in their pain to their bias. It was

abuse in my mind and I think we need to consider all things that might help the

benefit as we practice to the standard of providing adequate pain relief. s. fuchs dc

From:

@grou ps.com [mailto:] On Behalf Of joe medlin

Sent: Friday, November 07, 2008

10:22 AM

Lindekugel; Marc Heller;

glenntamearthlink (DOT) net ; W. Pfeiffer , DC

Cc:

Subject: Re: Fw:

LBP case... follow up2



Despite the fact that the risks may be remote, it's advisable for a

patients to understand that arachnoiditis, nerve root damage, infection etc.

are inherant risks. Not to mention the damage the steroid does to the rest of

the body. Theres a reason they only allow 3/year. They only help about 50% and

thats only temporary. THey should be reserved for extreme cases of

stenosis in my opinion not a mild bulge such as we see in this case. An

argument can also be made that it will slow healing time down in the long run.

ph Medlin D.C.

Spine Tree Chiropractic

1607 NE Alberta St .

PDX, OR 97211

www.spinetreepdx. com

* Re: LBP case

>

>

> >

> > I have a 52yr old male (desk worker) with severe

> LBP(8/10 VAS),

> gradual onset over the coarse of a few hours, about 2

> weeks ago.

> Pain levels have been increasing, and now he is also

> getting a "numb

> feeling" into his anterior left thigh, medial knee and medial

> proximal calf. His only position of relief for LBP is

> squatting.

> Can't find relief for the numbness.

> >

> > exam: Initially neuro exam was negative but now loss

> (0/2) of

> Patella reflex on left. Sensation still intact, Lower

> extremity str

> all +5/5, except iliopsoas +3/5 due to local LBP, heel and

> toe walk

> neg. SLR/SLR max both neg. Kemps neg. Stretching of

> iliopsoas or

> piriformis gave an immediate relief of symptoms (1/10 VAS)

> >

> > I have done 3 treatments consisting of massage, stretch

> of affected

> muscles, microcurrent, and side posture manual adjustment.

> Home

> stretches were assigned. We also have a naturopath and an

> acupuncturist in our office and he received acupuncture as

> well as

> Trameel injections into the piriformis. Each treatment

> helped for a

> few days. Before symptoms would return, and worse than

> before. Home

> stretching only gives small and temporary relief.

> >

> > Due to appearance of neuro finding I sent him for a MRI:

> > finding: mild bulge with a small annular tear L4-5

> >

> > First any ideas for annular tears.

> >

> > Second, I am fairly confident that the leg numbness is a

> parathesia

> and is referred from the muscle spasm and not due to nerve

> root

> impingement. Due to the fact I am able to reduce the

> numbness and

> back pain with in-office stretching, SLR max is negative and

> adjusting helps so dramatically and quickly.

> >

> > However I am concerned about the loss of patellar

> reflex, and the

> patient is concerned about long term neurological

> ramifications, so

> does anyone have a good neuro referral in the East side of

> Portland .

> >

> > thank you all in advance.

> >

> > Glenn Sykes, DC

> > Gresham/Newberg, Oregon

> > 503-550-8806

> >Don't give up to soon. Ultrasound right over the piriformis

> (O,I,Belly)everytim e and stretching to release it will

> help. Getting

> the inflamation down in the piriformis is critical. I have

> seen the

> reflexes come back to normal in two to three weeks.

>

> Brad Rethwill , DC

> Eugene , OR

>

>

> ------------ --------- --------- --------- --------- --------- -

>

>

> No virus found in this incoming message.

> Checked by AVG - http://www.avg.

com

> Version: 8.0.175 / Virus Database: 270.8.6/1768 - Release Date: 11/4/2008

9:38 PM

>

>

------------ --------- --------- ------

All posts must adhere to OregonDCs rules located on homepage at: http://groups.

/ group//

Tell a colleague about OregonDCs! (must be licensed Oregon DC )

[Guest guest]

No, I am not joking. We aren’t in theirbrains or in their offices with their patients making medical decisions. Ifirmly believe if we want to get more patients in our doors then it is up to usto do the groundwork of educating not only potential patients but otherhealthcare providers. We also need much more research documenting healthoutcomes. And we need to affirmatively make statements amongst ourselves wherewe can improve. s. fuchs dc From: Lindekugel[mailto:pdxchiroguy@...] Sent: Tuesday, November 11, 20089:38 AMSharron Fuchs; DC ListserveSubject: Re: Fw:LBP case... follow up2 " We know little or nothing about themedical profession and they know little or nothing about us. " Yougotta be joking here, right?! Most of us were brought up in the medicalsystem. If you had graduated from WSCC in the late 90's you would havereceived - largely - a medical education focused on manual medicine,labratory diagnosis and chiropractic. Very few of our friends in medicinehave entered a chiropractors office. Very few are familiar with thehundreds of research articles on chiropractic. Even when Osteopaths makethe case for osteiopathic manipulation, they use 75% chiropractic research toback it up. Further, my 11th quarter at WSCC, my clinician and myself went up on the hillto demonstrate chiropractic during the family medicine rounds. Theythought we were the most professional " witch doctors " they had everseen. You can learn a lot from someone by the questions they ask. What I learned was that they had no idea what a chiropractor was. I amsure that has improved some over the last 8 years.I would say that they know VERY little about us, but we know a lot about them.Yet we still do research at our clinic, and I make the effort every hour toinform my patients and their PCP, what we do. It is getting better.Jay Lindekugel, DCConcordia Chiropractic Center From: Sharron Fuchs<sharronf@...> Sent: Monday, November 10, 200811:10:37 AMSubject: RE: Fw:LBP case... follow up2I often read commentary on this list serve that is outright basingof the medical profession. I am a DC. A DC commenting on DC care isintraprofessional critique which is what we should do more of. We know littleor nothing about the medical profession and they know little or nothing aboutus. If we keep the focus on us we can improve and expand our knowledge andview. ‘Cut , Burn and Poison’ was the mantra spewed at WSCC when I wasthere. I hear it used by DC’s still. s. fuchs dc From: Lindekugel [mailto:pdxchiroguy @] Sent: Friday, November 07, 20085:24 PMSharron Fuchs;@grou ps.comSubject: Re: Fw: LBPcase... follow up2 I guess that isjust it. I don't see anybody saying ‘You hear me Darla, all MD’s are nothing but cut, burn and poison.There is nothing they do or say that can help you. Only I can helpyou………………….’. Who is doingthis? Is this what you think we are saying to our patients? I thinkthe comments below and discussing the dangers (namely backed by numbers) isjust what we are supposed to be aware of as responsible physicians. Thisis not MD bashing any more than you sharing your encounter with thechiropractor and the 90 year old was chiro-bashing.Jay Lindekugel, DCConcordia Chiropractic CenterFrom: Sharron Fuchs <sharronf@tdinjuryla w.com> Lindekugel<pdxchiroguy>; @grou ps.comSent: Friday, November 7, 20084:19:21 PMSubject: RE: Fw:LBP case... follow up2You know darn well that is not what I mean. Bad mouth = ‘You hearme Darla, all MD’s are nothing but cut, burn and poison. There is nothing theydo or say that can help you. Only I can help you………………….’ s. fuchs dc From: Lindekugel [mailto:pdxchiroguy @] Sent: Friday, November 07, 20084:13 PMSharron Fuchs;@grou ps.comSubject: Re: Fw:LBP case... follow up2 If by " bad mouth " you mean explaining to patients facedwith difficult decisions the importance of weighing the risk benefit ratio ofdifferent procedures - including chiropractic -... ...guilty as charged.Jay Lindekugel, DCConcordia Chiropractic Center From: Sharron Fuchs <sharronf@tdinjuryla w.com>@grou ps.comSent: Friday, November 7, 20082:36:44 PMSubject: RE: Fw:LBP case... follow up2 Yes, there are many stories to go around. For us, I think weshould not bad mouth others but rather seek ways for us to improve what we do. s. fuchs dc From: Lindekugel [mailto:pdxchiroguy @] Sent: Friday, November 07, 20081:55 PMSharron Fuchs;@grou ps.comSubject: Re: Fw:LBP case... follow up2 Agreed. Andthanks for the article reference. That was very helpful. I am sure we areall guilty of a little bias in our decision making. But I would say thaton balance, we do less harm than our medical counterparts when it comes todiagnosing and treating patients.A year ago I attended one of many Pain Society of Oregon meetings where theywere having a panel discussion about some difficult cases one of theneurologists in the group had brought to discuss. The first case was awomen in her 50's who had been suffering from severe debilitating headpain. Many drugs had been tried over the years - mostly opiates. When that failed, they decided to remove part of her BRAIN - no change. They turned to the acupuncturist and chiropractor on the panel to discusstreatment options. Both discussed how they might begin to work with thisindividual. The main point not made was that chiropractic and acupunctureshould have been tried BEFORE taking part of this poor woman's brain out andthey created a severe depletion of neurotransmitters, hormone imbalances andGod know what else. Most of us see this side of the story too often, and I think accounts for someof our zealous behavior. You have seen the other side. It isinexcusable, and we should all be honest about our patient's options and makecertain that they are consenting and knowledgeable. Not everyone wants what we have to offer. If they are not on board, theyshould be given a choice of alternatives - with your professional " take " on what you think is best for their health. But most ofus have seen countless patients who have been held " hostage " bybiased medical practitioners. Patients who say, " I don't know why myMD thought you were going to paralyze me, this is the best thing I have everdone for my health! I am so happy my friend/loved one talked me intoseeing you. " Jay Lindekugel, DCConcordia Chiropractic and MovementCenter From: Sharron Fuchs <sharronf@tdinjuryla w.com>@grou ps.comSent: Friday, November 7, 200811:04:29 AMSubject: RE: Fw:LBP case... follow up2Of course. They need to wake up too to what can be a legitimateoption for the patient. We have to be smarter. We also have to accept the ideaand even admit that there are risks to our treatments also. s. fuchs From: @grou ps.com [mailto:] On Behalf Of SeitzSent: Friday, November 07, 200811:02 AM@grou ps.comSubject: RE: Fw:LBP case... follow up2 Of course the flip-side to this is the very common bias againstwhat chiropractors do by the medical profession, especially when related tomanual adjusting of the upper cervical spine. Seitz, DC From: @grou ps.com [mailto:groups (DOT) com] On Behalf Of SharronFuchsSent: Friday, November 07, 200810:35 AMSubject: RE: Fw:LBP case... follow up2 Only the patient can make the determination of their pain level andwhat options they wish to try for relief. I don’t think it is up to us to biasthem about all the negatives when in some cases it might be of great benefit. Iknow you know that. I don’t want to argue about it but this is a sensitivepoint for me as I was posting in the past about a 90 year old person who wassuffering terribly and the DC that was treating them essentially held themhostage in their pain to their bias. It was abuse in my mind and I think weneed to consider all things that might help the benefit as we practice to thestandard of providing adequate pain relief. s. fuchs dc From: @grou ps.com [mailto:groups (DOT) com] On Behalf Of joemedlinSent: Friday, November 07, 200810:22 AM Lindekugel; Marc Heller;glenntamearthlink (DOT) net ; W. Pfeiffer, DCCc: Subject: Re: Fw:LBP case... follow up2  Despite the factthat the risks may be remote, it's advisable for a patients to understand thatarachnoiditis, nerve root damage, infection etc. are inherant risks. Not tomention the damage the steroid does to the rest of the body. Theres a reasonthey only allow 3/year. They only help about 50% and thats onlytemporary. THey should be reserved for extreme cases of stenosis in myopinion not a mild bulge such as we see in this case. An argument can also bemade that it will slow healing time down in the long run. ph Medlin D.C.Spine Tree Chiropractic1607 NE Alberta St. PDX, OR 97211www.spinetreepdx. com Re: Re: LBP case>> Excuse my ignorance, but Trameel injections?? ?> > Sounds to me like the n. root is the main culprit of pain> referral especially with reflex loss and Spasm etc. is most> likely the cause of that irritation. It is curious that he > gets relief from stretching etc, but with a mild bulge many> times the symptoms aren't as constant and clear as a full on> herniation. In my opinion i'd also be sure to be very gentle> with stretching in order to not irritate the nerve and> gradually increase intensity. As you know a mild bulge will> relent much faster than a herniation so treat and monitor.> > me 2 cents on this wonderful Obama morning,,,,, ,,> sorry, couldnt resist.> > ph Medlin D.C.> Spine Tree Chiropractic> 1607 NE Alberta St.> PDX, OR 97211> www.spinetreepdx. com <http://www.spinetre epdx.com>>> * Re: LBP case>> > >> > I have a 52yr old male (desk worker) with severe> LBP(8/10 VAS),> gradual onset over the coarse of a few hours, about 2> weeks ago.> Pain levels have been increasing, and now he is also> getting a " numb> feeling " into his anterior left thigh, medial knee and medial> proximal calf. His only position of relief for LBP is> squatting.> Can't find relief for the numbness.> >> > exam: Initially neuro exam was negative but now loss> (0/2) of> Patella reflex on left. Sensation still intact, Lower> extremity str> all +5/5, except iliopsoas +3/5 due to local LBP, heel and> toe walk> neg. SLR/SLR max both neg. Kemps neg. Stretching of> iliopsoas or> piriformis gave an immediate relief of symptoms (1/10 VAS)> >> > I have done 3 treatments consisting of massage, stretch> of affected> muscles, microcurrent, and side posture manual adjustment.> Home> stretches were assigned. We also have a naturopath and an> acupuncturist in our office and he received acupuncture as> well as> Trameel injections into the piriformis. Each treatment> helped for a> few days. Before symptoms would return, and worse than> before. Home> stretching only gives small and temporary relief.> >> > Due to appearance of neuro finding I sent him for a MRI:> > finding: mild bulge with a small annular tear L4-5> >> > First any ideas for annular tears.> >> > Second, I am fairly confident that the leg numbness is a> parathesia> and is referred from the muscle spasm and not due to nerve> root> impingement. Due to the fact I am able to reduce the> numbness and> back pain with in-office stretching, SLR max is negative and> adjusting helps so dramatically and quickly.> >> > However I am concerned about the loss of patellar> reflex, and the> patient is concerned about long term neurological> ramifications, so> does anyone have a good neuro referral in the East side of> Portland .> >> > thank you all in advance.> >> > Glenn Sykes, DC> > Gresham/Newberg, Oregon> > 503-550-8806> >Don't give up to soon. Ultrasound right over the piriformis> (O,I,Belly)everytim e and stretching to release it will> help. Getting> the inflamation down in the piriformis is critical. I have> seen the> reflexes come back to normal in two to three weeks.>> Brad Rethwill , DC> Eugene , OR>> > ------------ --------- --------- --------- --------- --------- ->>> No virus found in this incoming message.> Checked by AVG - http://www.avg.com > Version: 8.0.175 / Virus Database: 270.8.6/1768 - Release Date: 11/4/20089:38 PM>> ------------ --------- --------- ------All posts must adhere to OregonDCs rules located on homepage at: group//Tell a colleague about OregonDCs! (must be licensed Oregon DC)

[Guest guest]



Just to let you know and because it is relevant to this exact conversation:

Patient just came in the door a couple hours ago. long story short, she had a Neuro surgical evaluation for lumbar injury. The Neuro didnt recommend surgery. She returned to her PCP at PRovidence who proceeded to tell her that "this is not an area in which i'm familiar, what is it you would like to do?"

Patient response:

"I'd really like to get some chiropractic done"

Doctor:

"I don't recommend that, but if you wish go ahead."

Now what the hell is that. THis is an area that she admits is out of her expertise and yet she claims to not wish to recommend to a doctor who's expertise it is?

Look, it is THEIR responsibility to know what will benefit their patients. This doctor (if you want to call her that) is young and has NO excuse of ignorance of our profession.

This is the kind of CRAP we deal with on a daily basis. A patient tells her chiropractor that she wishes to see the MD and we say GO!!

I really don't care and am not sitting in my office trying to make connections with MD"s to get referrals. This is about what is best for the patients out there and they seem to have a bias many times.

ph Medlin D.C.Spine Tree Chiropractic1607 NE Alberta St. PDX, OR 97211www.spinetreepdx.com

* Re: LBP case>> > >> > I have a 52yr old male (desk worker) with severe> LBP(8/10 VAS),> gradual onset over the coarse of a few hours, about 2> weeks ago.> Pain levels have been increasing, and now he is also> getting a "numb> feeling" into his anterior left thigh, medial knee and medial> proximal calf. His only position of relief for LBP is> squatting.> Can't find relief for the numbness.> >> > exam: Initially neuro exam was negative but now loss> (0/2) of> Patella reflex on left. Sensation still intact, Lower> extremity str> all +5/5, except iliopsoas +3/5 due to local LBP, heel and> toe walk> neg. SLR/SLR max both neg. Kemps neg. Stretching of> iliopsoas or> piriformis gave an immediate relief of symptoms (1/10 VAS)> >> > I have done 3 treatments consisting of massage, stretch> of affected> muscles, microcurrent, and side posture manual adjustment.> Home> stretches were assigned. We also have a naturopath and an> acupuncturist in our office and he received acupuncture as> well as> Trameel injections into the piriformis. Each treatment> helped for a> few days. Before symptoms would return, and worse than> before. Home> stretching only gives small and temporary relief.> >> > Due to appearance of neuro finding I sent him for a MRI:> > finding: mild bulge with a small annular tear L4-5> >> > First any ideas for annular tears.> >> > Second, I am fairly confident that the leg numbness is a> parathesia> and is referred from the muscle spasm and not due to nerve> root> impingement. Due to the fact I am able to reduce the> numbness and> back pain with in-office stretching, SLR max is negative and> adjusting helps so dramatically and quickly.> >> > However I am concerned about the loss of patellar> reflex, and the> patient is concerned about long term neurological> ramifications, so> does anyone have a good neuro referral in the East side of> Portland .> >> > thank you all in advance.> >> > Glenn Sykes, DC> > Gresham/Newberg, Oregon> > 503-550-8806> >Don't give up to soon. Ultrasound right over the piriformis> (O,I,Belly)everytim e and stretching to release it will> help. Getting> the inflamation down in the piriformis is critical. I have> seen the> reflexes come back to normal in two to three weeks.>> Brad Rethwill , DC> Eugene , OR>> > ------------ --------- --------- --------- --------- --------- ->>> No virus found in this incoming message.> Checked by AVG - http://www.avg. com > Version: 8.0.175 / Virus Database: 270.8.6/1768 - Release Date: 11/4/2008 9:38 PM>> ------------ --------- --------- ------All posts must adhere to OregonDCs rules located on homepage at: http://groups. / group//Tell a colleague about OregonDCs! (must be licensed Oregon DC )

[Guest guest]

I am assuming that you mean promote the profession and not "get more people through our doors". As to the rest, already happening in chiropractic offices every day all over the world. Jay From: Sharron Fuchs <sharronf@...>DC Listserve < >Sent: Tuesday, November 11, 2008

11:33:03 AMSubject: RE: Fw: LBP case... follow up2

No, I am not joking. We aren’t in their

brains or in their offices with their patients making medical decisions. I

firmly believe if we want to get more patients in our doors then it is up to us

to do the groundwork of educating not only potential patients but other

healthcare providers. We also need much more research documenting health

outcomes. And we need to affirmatively make statements amongst ourselves where

we can improve. s. fuchs dc

From: Lindekugel

[mailto:pdxchiroguy @]

Sent: Tuesday, November 11, 2008

9:38 AM

Sharron Fuchs; DC Listserve

Subject: Re: Fw:

LBP case... follow up2

"We know little or nothing about the

medical profession and they know little or nothing about us." You

gotta be joking here, right?! Most of us were brought up in the medical

system. If you had graduated from WSCC in the late 90's you would have

received - largely - a medical education focused on manual medicine,

labratory diagnosis and chiropractic. Very few of our friends in medicine

have entered a chiropractors office. Very few are familiar with the

hundreds of research articles on chiropractic. Even when Osteopaths make

the case for osteiopathic manipulation, they use 75% chiropractic research to

back it up.

Further, my 11th quarter at WSCC, my clinician and myself went up on the hill

to demonstrate chiropractic during the family medicine rounds. They

thought we were the most professional "witch doctors" they had ever

seen. You can learn a lot from someone by the questions they ask.

What I learned was that they had no idea what a chiropractor was. I am

sure that has improved some over the last 8 years.

I would say that they know VERY little about us, but we know a lot about them.

Yet we still do research at our clinic, and I make the effort every hour to

inform my patients and their PCP, what we do. It is getting better.

Jay

Lindekugel, DC

Concordia Chiropractic Center

From: Sharron Fuchs

<sharronf@tdinjuryla w.com>

@grou ps.com

Sent: Monday, November 10, 2008

11:10:37 AM

Subject: RE: Fw:

LBP case... follow up2

I often read commentary on this list serve that is outright basing

of the medical profession. I am a DC. A DC commenting on DC care is

intraprofessional critique which is what we should do more of. We know little

or nothing about the medical profession and they know little or nothing about

us. If we keep the focus on us we can improve and expand our knowledge and

view. ‘Cut , Burn and Poison’ was the mantra spewed at WSCC when I was

there. I hear it used by DC’s still. s. fuchs dc

From: Lindekugel [mailto:pdxchiroguy @]

Sent: Friday, November 07, 2008

5:24 PM

Sharron Fuchs;

@grou ps.com

Subject: Re: Fw: LBP

case... follow up2

I guess that is

just it. I don't see anybody saying ‘You hear me Darla, all MD’s are nothing but cut, burn and poison.

There is nothing they do or say that can help you. Only I can help

you………………….’.

Who is doing

this? Is this what you think we are saying to our patients? I think

the comments below and discussing the dangers (namely backed by numbers) is

just what we are supposed to be aware of as responsible physicians. This

is not MD bashing any more than you sharing your encounter with the

chiropractor and the 90 year old was chiro-bashing.

Jay

Lindekugel, DC

Concordia Chiropractic Center

From: Sharron Fuchs <sharronf@tdinjuryla w.com>

Lindekugel

<pdxchiroguy>; @grou ps.com

Sent: Friday, November 7, 2008

4:19:21 PM

Subject: RE: Fw:

LBP case... follow up2

You know darn well that is not what I mean. Bad mouth = ‘You hear

me Darla, all MD’s are nothing but cut, burn and poison. There is nothing they

do or say that can help you. Only I can help you………………….’ s. fuchs dc

From: Lindekugel [mailto:pdxchiroguy @]

Sent: Friday, November 07, 2008

4:13 PM

Sharron Fuchs;

@grou ps.com

Subject: Re: Fw:

LBP case... follow up2

If by "bad mouth" you mean explaining to patients faced

with difficult decisions the importance of weighing the risk benefit ratio of

different procedures - including chiropractic -

.... ...guilty as charged.

Jay

Lindekugel, DC

Concordia Chiropractic Center

From: Sharron Fuchs <sharronf@tdinjuryla w.com>

@grou ps.com

Sent: Friday, November 7, 2008

2:36:44 PM

Subject: RE: Fw:

LBP case... follow up2

Yes, there are many stories to go around. For us, I think we

should not bad mouth others but rather seek ways for us to improve what we do. s. fuchs dc

From: Lindekugel [mailto:pdxchiroguy @]

Sent: Friday, November 07, 2008

1:55 PM

Sharron Fuchs;

@grou ps.com

Subject: Re: Fw:

LBP case... follow up2

Agreed. And

thanks for the article reference. That was very helpful. I am sure we are

all guilty of a little bias in our decision making. But I would say that

on balance, we do less harm than our medical counterparts when it comes to

diagnosing and treating patients.

A year ago I attended one of many Pain Society of Oregon meetings where they

were having a panel discussion about some difficult cases one of the

neurologists in the group had brought to discuss. The first case was a

women in her 50's who had been suffering from severe debilitating head

pain. Many drugs had been tried over the years - mostly opiates.

When that failed, they decided to remove part of her BRAIN - no change.

They turned to the acupuncturist and chiropractor on the panel to discuss

treatment options. Both discussed how they might begin to work with this

individual. The main point not made was that chiropractic and acupuncture

should have been tried BEFORE taking part of this poor woman's brain out and

they created a severe depletion of neurotransmitters, hormone imbalances and

God know what else.

Most of us see this side of the story too often, and I think accounts for some

of our zealous behavior. You have seen the other side. It is

inexcusable, and we should all be honest about our patient's options and make

certain that they are consenting and knowledgeable.

Not everyone wants what we have to offer. If they are not on board, they

should be given a choice of alternatives - with your professional

"take" on what you think is best for their health. But most of

us have seen countless patients who have been held "hostage" by

biased medical practitioners. Patients who say, "I don't know why my

MD thought you were going to paralyze me, this is the best thing I have ever

done for my health! I am so happy my friend/loved one talked me into

seeing you."

Jay

Lindekugel, DC

Concordia Chiropractic and Movement Center

From: Sharron Fuchs <sharronf@tdinjuryla w.com>

@grou ps.com

Sent: Friday, November 7, 2008

11:04:29 AM

Subject: RE: Fw:

LBP case... follow up2

Of course. They need to wake up too to what can be a legitimate

option for the patient. We have to be smarter. We also have to accept the idea

and even admit that there are risks to our treatments also. s. fuchs

From: @grou ps.com [mailto:] On Behalf Of Seitz

Sent: Friday, November 07, 2008

11:02 AM

@grou ps.com

Subject: RE: Fw:

LBP case... follow up2

Of course the flip-side to this is the very common bias against

what chiropractors do by the medical profession, especially when related to

manual adjusting of the upper cervical spine. Seitz, DC

From: @grou ps.com [mailto:@

groups. com] On Behalf Of Sharron

Fuchs

Sent: Friday, November 07, 2008

10:35 AM

Subject: RE: Fw:

LBP case... follow up2

Only the patient can make the determination of their pain level and

what options they wish to try for relief. I don’t think it is up to us to bias

them about all the negatives when in some cases it might be of great benefit. I

know you know that. I don’t want to argue about it but this is a sensitive

point for me as I was posting in the past about a 90 year old person who was

suffering terribly and the DC that was treating them essentially held them

hostage in their pain to their bias. It was abuse in my mind and I think we

need to consider all things that might help the benefit as we practice to the

standard of providing adequate pain relief. s. fuchs dc

From: @grou ps.com [mailto:@

groups. com] On Behalf Of joe

medlin

Sent: Friday, November 07, 2008

10:22 AM

Lindekugel; Marc Heller;

glenntamearthlink (DOT) net ; W. Pfeiffer , DC

Cc:

Subject: Re: Fw:

LBP case... follow up2



Despite the fact

that the risks may be remote, it's advisable for a patients to understand that

arachnoiditis, nerve root damage, infection etc. are inherant risks. Not to

mention the damage the steroid does to the rest of the body. Theres a reason

they only allow 3/year. They only help about 50% and thats only

temporary. THey should be reserved for extreme cases of stenosis in my

opinion not a mild bulge such as we see in this case. An argument can also be

made that it will slow healing time down in the long run.

ph Medlin D.C.

Spine Tree Chiropractic

1607 NE Alberta St .

PDX, OR 97211

www.spinetreepdx. com

-----

Original Message -----

From:

Lindekugel

joe

medlin ; Marc

Heller ; glenntamearthlink (DOT)

net ; W.

Pfeiffer, DC

Cc:

Sent: Friday, November 07, 2008 9:01 AM

Subject: Re: Fw: LBP case... follow up2

Do any of you have

good statistics on the prevalence of acute arachnoiditis with this

procedure? It would be helpful for patients who are weighing the

risk/benefit ratio.

Jay

Lindekugel, DC

Concordia Chiropractic Center

5425 NE 33rd Ave.

From: joe medlin <spinetree@qwestoffi ce.net>

Marc Heller <mheller@marchellerd c.com>; glenntamearthlink (DOT) net;

" W. Pfeiffer , DC " <drboboregontrail (DOT) net>

Cc: <@grou ps.com>

Sent: Thursday, November 6, 2008

6:29:48 PM

Subject: Re: Fw:

LBP case... follow up2



I was hoping i

wasn't the only one who thought that was invasive. These cases can be very

effectively treated via standard chiropractic treatment.

ph Medlin D.C.

Spine Tree Chiropractic

1607 NE Alberta St .

PDX, OR 97211

www.spinetreepdx. com

-----

Original Message -----

From: W.

Pfeiffer, DC

'Marc

Heller' ; glenntamearthlink (DOT)

net

Cc: ''

Sent: Thursday, November 06, 2008 5:36 PM

Subject: RE: Fw: LBP case... follow up2

Hi Marc

Are epidural injections worth the risk of acute arachnoiditis? ??

Bob

W. Pfeiffer , DC , DABCO

P. O. Box 606

Pendleton Or 97801

541-276-2550

Re: Re: LBP case

>

> Excuse my ignorance, but Trameel injections?? ?

>

> Sounds to me like the n. root is the main culprit of pain

> referral especially with reflex loss and Spasm etc. is most

> likely the cause of that irritation. It is curious that he

> gets relief from stretching etc, but with a mild bulge many

> times the symptoms aren't as constant and clear as a full on

> herniation. In my opinion i'd also be sure to be very gentle

> with stretching in order to not irritate the nerve and

> gradually increase intensity. As you know a mild bulge will

> relent much faster than a herniation so treat and monitor.

>

> me 2 cents on this wonderful Obama morning,,,,, ,,

> sorry, couldnt resist.

>

> ph Medlin D.C.

> Spine Tree Chiropractic

> 1607 NE Alberta St .

> PDX, OR 97211

> www.spinetreepdx. com <http://www.spinetre epdx.com>

>

> * Re: LBP case

>

>

> >

> > I have a 52yr old male (desk worker) with severe

> LBP(8/10 VAS),

> gradual onset over the coarse of a few hours, about 2

> weeks ago.

> Pain levels have been increasing, and now he is also

> getting a "numb

> feeling" into his anterior left thigh, medial knee and medial

> proximal calf. His only position of relief for LBP is

> squatting.

> Can't find relief for the numbness.

> >

> > exam: Initially neuro exam was negative but now loss

> (0/2) of

> Patella reflex on left. Sensation still intact, Lower

> extremity str

> all +5/5, except iliopsoas +3/5 due to local LBP, heel and

> toe walk

> neg. SLR/SLR max both neg. Kemps neg. Stretching of

> iliopsoas or

> piriformis gave an immediate relief of symptoms (1/10 VAS)

> >

> > I have done 3 treatments consisting of massage, stretch

> of affected

> muscles, microcurrent, and side posture manual adjustment.

> Home

> stretches were assigned. We also have a naturopath and an

> acupuncturist in our office and he received acupuncture as

> well as

> Trameel injections into the piriformis. Each treatment

> helped for a

> few days. Before symptoms would return, and worse than

> before. Home

> stretching only gives small and temporary relief.

> >

> > Due to appearance of neuro finding I sent him for a MRI:

> > finding: mild bulge with a small annular tear L4-5

> >

> > First any ideas for annular tears.

> >

> > Second, I am fairly confident that the leg numbness is a

> parathesia

> and is referred from the muscle spasm and not due to nerve

> root

> impingement. Due to the fact I am able to reduce the

> numbness and

> back pain with in-office stretching, SLR max is negative and

> adjusting helps so dramatically and quickly.

> >

> > However I am concerned about the loss of patellar

> reflex, and the

> patient is concerned about long term neurological

> ramifications, so

> does anyone have a good neuro referral in the East side of

> Portland .

> >

> > thank you all in advance.

> >

> > Glenn Sykes, DC

> > Gresham/Newberg, Oregon

> > 503-550-8806

> >Don't give up to soon. Ultrasound right over the piriformis

> (O,I,Belly)everytim e and stretching to release it will

> help. Getting

> the inflamation down in the piriformis is critical. I have

> seen the

> reflexes come back to normal in two to three weeks.

>

> Brad Rethwill , DC

> Eugene , OR

>

>

> ------------ --------- --------- --------- --------- --------- -

>

>

> No virus found in this incoming message.

> Checked by AVG - http://www.avg.

com

> Version: 8.0.175 / Virus Database: 270.8.6/1768 - Release Date: 11/4/2008

9:38 PM

>

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Perfect time for you to send a nice letterof thanks for the ‘referral’ with your assessment ! s. fuchs dc From: joe medlin[mailto:spinetree@...] Sent: Tuesday, November 11, 200812:16 PMDC Listserve; Sharron FuchsSubject: Re: Fw:LBP case... follow up2 Just to let you know and because it is relevant to this exactconversation:Patient just came in the door a couple hours ago. long story short, shehad a Neuro surgical evaluation for lumbar injury. The Neuro didntrecommend surgery. She returned to her PCP at PRovidence who proceeded to tell her that " this is not an area in which i'm familiar, what is it you would like todo? " Patient response: " I'd really like to get some chiropractic done " Doctor: " I don't recommend that, but if you wish go ahead. " Now what the hell is that. THis is an area that she admits is out ofher expertise and yet she claims to not wish to recommend to a doctor who'sexpertise it is? Look, it is THEIR responsibility to know what will benefit theirpatients. This doctor (if you want to call her that) is young and has NO excuseof ignorance of our profession. This is the kind of CRAP we deal with on a daily basis. A patienttells her chiropractor that she wishes to see the MD and we say GO!! I really don't care and am not sitting in my office trying to makeconnections with MD " s to get referrals. This is about what is best for thepatients out there and they seem to have a bias many times. ph Medlin D.C.Spine Tree Chiropractic1607 NE Alberta St.PDX, OR 97211www.spinetreepdx.com* Re: LBP case>> > >> > I have a 52yr old male (desk worker) with severe> LBP(8/10 VAS),> gradual onset over the coarse of a few hours, about 2> weeks ago.> Pain levels have been increasing, and now he is also> getting a " numb> feeling " into his anterior left thigh, medial knee and medial> proximal calf. His only position of relief for LBP is> squatting.> Can't find relief for the numbness.> >> > exam: Initially neuro exam was negative but now loss> (0/2) of> Patella reflex on left. Sensation still intact, Lower> extremity str> all +5/5, except iliopsoas +3/5 due to local LBP, heel and> toe walk> neg. SLR/SLR max both neg. Kemps neg. Stretching of> iliopsoas or> piriformis gave an immediate relief of symptoms (1/10 VAS)> >> > I have done 3 treatments consisting of massage, stretch> of affected> muscles, microcurrent, and side posture manual adjustment.> Home> stretches were assigned. We also have a naturopath and an> acupuncturist in our office and he received acupuncture as> well as> Trameel injections into the piriformis. Each treatment> helped for a> few days. Before symptoms would return, and worse than> before. Home> stretching only gives small and temporary relief.> >> > Due to appearance of neuro finding I sent him for a MRI:> > finding: mild bulge with a small annular tear L4-5> >> > First any ideas for annular tears.> >> > Second, I am fairly confident that the leg numbness is a> parathesia> and is referred from the muscle spasm and not due to nerve> root> impingement. Due to the fact I am able to reduce the> numbness and> back pain with in-office stretching, SLR max is negative and> adjusting helps so dramatically and quickly.> >> > However I am concerned about the loss of patellar> reflex, and the> patient is concerned about long term neurological> ramifications, so> does anyone have a good neuro referral in the East side of> Portland.> >> > thank you all in advance.> >> > Glenn Sykes, DC> > Gresham/Newberg, Oregon> > 503-550-8806> >Don't give up to soon. Ultrasound right over the piriformis> (O,I,Belly)everytim e and stretching to release it will> help. Getting> the inflamation down in the piriformis is critical. I have> seen the> reflexes come back to normal in two to three weeks.>> Brad Rethwill, DC> Eugene, OR>> > ------------ --------- --------- --------- --------- --------- ->>> No virus found in this incoming message.> Checked by AVG - http://www.avg.com > Version: 8.0.175 / Virus Database: 270.8.6/1768 - Release Date: 11/4/20089:38 PM>> ------------ --------- --------- ------All posts must adhere to OregonDCs rules located on homepage at: group//Tell a colleague about OregonDCs! (must be licensed Oregon DC)

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What the heck is wrong with you Joe, turn that other cheek dude. I am sure it will change the opinion of the god plexed MD.

Danno

* Re: LBP case>> > >> > I have a 52yr old male (desk worker) with severe> LBP(8/10 VAS),> gradual onset over the coarse of a few hours, about 2> weeks ago.> Pain levels have been increasing, and now he is also> getting a "numb> feeling" into his anterior left thigh, medial knee and medial> proximal calf. His only position of relief for LBP is> squatting.> Can't find relief for the numbness.> >> > exam: Initially neuro exam was negative but now loss> (0/2) of> Patella reflex on left. Sensation still intact, Lower> extremity str> all +5/5, except iliopsoas +3/5 due to local LBP, heel and> toe walk> neg. SLR/SLR max both neg. Kemps neg. Stretching of> iliopsoas or> piriformis gave an immediate relief of symptoms (1/10 VAS)> >> > I have done 3 treatments consisting of massage, stretch> of affected> muscles, microcurrent, and side posture manual adjustment.> Home> stretches were assigned. We also have a naturopath and an> acupuncturist in our office and he received acupuncture as> well as> Trameel injections into the piriformis. Each treatment> helped for a> few days. Before symptoms would return, and worse than> before. Home> stretching only gives small and temporary relief.> >> > Due to appearance of neuro finding I sent him for a MRI:> > finding: mild bulge with a small annular tear L4-5> >> > First any ideas for annular tears.> >> > Second, I am fairly confident that the leg numbness is a> parathesia> and is referred from the muscle spasm and not due to nerve> root> impingement. Due to the fact I am able to reduce the> numbness and> back pain with in-office stretching, SLR max is negative and> adjusting helps so dramatically and quickly.> >> > However I am concerned about the loss of patellar> reflex, and the> patient is concerned about long term neurological> ramifications, so> does anyone have a good neuro referral in the East side of> Portland .> >> > thank you all in advance.> >> > Glenn Sykes, DC> > Gresham/Newberg, Oregon> > 503-550-8806> >Don't give up to soon. Ultrasound right over the piriformis> (O,I,Belly)everytim e and stretching to release it will> help. Getting> the inflamation down in the piriformis is critical. I have> seen the> reflexes come back to normal in two to three weeks.>> Brad Rethwill , DC> Eugene , OR>> > ------------ --------- --------- --------- --------- --------- ->>> No virus found in this incoming message.> Checked by AVG - http://www.avg. com > Version: 8.0.175 / Virus Database: 270.8.6/1768 - Release Date: 11/4/2008 9:38 PM>> ------------ --------- --------- ------All posts must adhere to OregonDCs rules located on homepage at: http://groups. / group//Tell a colleague about OregonDCs! (must be licensed Oregon DC )

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Hahahha,

Only, she came to me of her own free will. The MD recommended AGAINST coming to see me and did NOT refer her.

Now thats just it. I suppose i could send her a letter explaining how i could have helped this patient and to consider chiropractic in the future, but I don't have the time for that and frankly am not hard up enough for business to cater to members of a health professioin who are too lazy to become informed in order to treat THEIR patients spinal injuries more effectively!

That being said, healthy relationships between our professions is necessary, but some of us are tired of the futile leg work. Those MD's who want to know what we do will find out.

This MD admitted that the spine was not an "area she knew a lot about", but she seemed to know enough about it to recommend against chiropractic?

Ludicrous and not worth my time.

ph Medlin D.C.Spine Tree Chiropractic1607 NE Alberta St. PDX, OR 97211www.spinetreepdx.com

* Re: LBP case>> > >> > I have a 52yr old male (desk worker) with severe> LBP(8/10 VAS),> gradual onset over the coarse of a few hours, about 2> weeks ago.> Pain levels have been increasing, and now he is also> getting a "numb> feeling" into his anterior left thigh, medial knee and medial> proximal calf. His only position of relief for LBP is> squatting.> Can't find relief for the numbness.> >> > exam: Initially neuro exam was negative but now loss> (0/2) of> Patella reflex on left. Sensation still intact, Lower> extremity str> all +5/5, except iliopsoas +3/5 due to local LBP, heel and> toe walk> neg. SLR/SLR max both neg. Kemps neg. Stretching of> iliopsoas or> piriformis gave an immediate relief of symptoms (1/10 VAS)> >> > I have done 3 treatments consisting of massage, stretch> of affected> muscles, microcurrent, and side posture manual adjustment.> Home> stretches were assigned. We also have a naturopath and an> acupuncturist in our office and he received acupuncture as> well as> Trameel injections into the piriformis. Each treatment> helped for a> few days. Before symptoms would return, and worse than> before. Home> stretching only gives small and temporary relief.> >> > Due to appearance of neuro finding I sent him for a MRI:> > finding: mild bulge with a small annular tear L4-5> >> > First any ideas for annular tears.> >> > Second, I am fairly confident that the leg numbness is a> parathesia> and is referred from the muscle spasm and not due to nerve> root> impingement. Due to the fact I am able to reduce the> numbness and> back pain with in-office stretching, SLR max is negative and> adjusting helps so dramatically and quickly.> >> > However I am concerned about the loss of patellar> reflex, and the> patient is concerned about long term neurological> ramifications, so> does anyone have a good neuro referral in the East side of> Portland .> >> > thank you all in advance.> >> > Glenn Sykes, DC> > Gresham/Newberg, Oregon> > 503-550-8806> >Don't give up to soon. Ultrasound right over the piriformis> (O,I,Belly)everytim e and stretching to release it will> help. Getting> the inflamation down in the piriformis is critical. I have> seen the> reflexes come back to normal in two to three weeks.>> Brad Rethwill , DC> Eugene , OR>> > ------------ --------- --------- --------- --------- --------- ->>> No virus found in this incoming message.> Checked by AVG - http://www.avg. com > Version: 8.0.175 / Virus Database: 270.8.6/1768 - Release Date: 11/4/2008 9:38 PM>> ------------ --------- --------- ------All posts must adhere to OregonDCs rules located on homepage at: http://groups. / group//Tell a colleague about OregonDCs! (must be licensed Oregon DC )

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heheh ...... all so VERY true ... except the stories I get from patietns rarely had the MD saying 'go' ....chucklechuckle ...skSunny Kierstyn, RN DC Fibromyalgia Care Center of Oregon 2677 Willakenzie Road, 7CEugene, Oregon, 97401541- 344- 0509; Fx; 541- 344- 0955 ; sharronf@...From: spinetree@...Date: Tue, 11 Nov 2008 12:16:03 -0800Subject: Re: Fw: LBP case... follow up2 Just to let you know and because it is relevant to this exact conversation:Patient just came in the door a couple hours ago. long story short, she had a Neuro surgical evaluation for lumbar injury. The Neuro didnt recommend surgery. She returned to her PCP at PRovidence who proceeded to tell her that "this is not an area in which i'm familiar, what is it you would like to do?" Patient response:"I'd really like to get some chiropractic done"Doctor:"I don't recommend that, but if you wish go ahead." Now what the hell is that. THis is an area that she admits is out of her expertise and yet she claims to not wish to recommend to a doctor who's expertise it is? Look, it is THEIR responsibility to know what will benefit their patients. This doctor (if you want to call her that) is young and has NO excuse of ignorance of our profession. This is the kind of CRAP we deal with on a daily basis. A patient tells her chiropractor that she wishes to see the MD and we say GO!! I really don't care and am not sitting in my office trying to make connections with MD"s to get referrals. This is about what is best for the patients out there and they seem to have a bias many times. ph Medlin D.C.Spine Tree Chiropractic1607 NE Alberta St. PDX, OR 97211www.spinetreepdx.com* Re: LBP case>> > >> > I have a 52yr old male (desk worker) with severe> LBP(8/10 VAS),> gradual onset over the coarse of a few hours, about 2> weeks ago.> Pain levels have been increasing, and now he is also> getting a "numb> feeling" into his anterior left thigh, medial knee and medial> proximal calf. His only position of relief for LBP is> squatting.> Can't find relief for the numbness.> >> > exam: Initially neuro exam was negative but now loss> (0/2) of> Patella reflex on left. Sensation still intact, Lower> extremity str> all +5/5, except iliopsoas +3/5 due to local LBP, heel and> toe walk> neg. SLR/SLR max both neg. Kemps neg. Stretching of> iliopsoas or> piriformis gave an immediate relief of symptoms (1/10 VAS)> >> > I have done 3 treatments consisting of massage, stretch> of affected> muscles, microcurrent, and side posture manual adjustment.> Home> stretches were assigned. We also have a naturopath and an> acupuncturist in our office and he received acupuncture as> well as> Trameel injections into the piriformis. Each treatment> helped for a> few days. Before symptoms would return, and worse than> before. Home> stretching only gives small and temporary relief.> >> > Due to appearance of neuro finding I sent him for a MRI:> > finding: mild bulge with a small annular tear L4-5> >> > First any ideas for annular tears.> >> > Second, I am fairly confident that the leg numbness is a> parathesia> and is referred from the muscle spasm and not due to nerve> root> impingement. Due to the fact I am able to reduce the> numbness and> back pain with in-office stretching, SLR max is negative and> adjusting helps so dramatically and quickly.> >> > However I am concerned about the loss of patellar> reflex, and the> patient is concerned about long term neurological> ramifications, so> does anyone have a good neuro referral in the East side of> Portland .> >> > thank you all in advance.> >> > Glenn Sykes, DC> > Gresham/Newberg, Oregon> > 503-550-8806> >Don't give up to soon. Ultrasound right over the piriformis> (O,I,Belly)everytim e and stretching to release it will> help. Getting> the inflamation down in the piriformis is critical. I have> seen the> reflexes come back to normal in two to three weeks.>> Brad Rethwill , DC> Eugene , OR>> > ------------ --------- --------- --------- --------- --------- ->>> No virus found in this incoming message.> Checked by AVG - http://www.avg. com > Version: 8.0.175 / Virus Database: 270.8.6/1768 - Release Date: 11/4/2008 9:38 PM>> ------------ --------- --------- ------All posts must adhere to OregonDCs rules located on homepage at: http://groups. / group//Tell a colleague about OregonDCs! (must be licensed Oregon DC )